小切口经腹膜外前路腰椎椎间融合术治疗复发性腰椎间盘突出症

 目的 探讨小切口经腹膜外前路腰椎椎间融合术（anterior lumbar interbody fusion,ALIF）治疗复发性腰椎间盘突出症的疗效。方法 2001年2月至2012年2月应用小切口经腹膜外ALIF手术治疗复发性腰椎间盘突出症患者20例,男8例,女12例;年龄44~68岁,平均（53.1±5.9）岁。术中均采用SynFrame拉钩系统及SynFix-LR腰椎前路椎间融合器。统计术中出血量、术后48 h引流量、手术时间及住院天数。于术后2天、3、6、12个月进行随访,采用Oswestry功能障碍指数（Oswestry disability index,ODI）和疼痛视觉模拟评分（visual analogue scale,VAS）对手术疗效进行评估。结果 所有患者均获得随访,随访时间12~110个月,平均（45.6±29.6）个月。术后疼痛VAS评分与ODI值均较术前明显下降,差异有统计学意义（P＜0.05）,术后2天、3个月、6个月、12个月比较差异无统计学意义（P＞0.05）。疼痛VAS评分由术前平均（7.7±0.7）分（5~8分）降至术后12个月平均（1.7±0.9）分（0~3分）,ODI值由术前平均80.6%±3.9%（69%~85%）降至术后12个月6.6%±1.3%（5%~11%）。术中出血量90~220 ml,平均（126.0±40.3） ml;术后48 h引流量35~63 ml,平均（47.5±7.6） ml;住院天数4~11 d,平均（6.7±1.8） d。术后6个月骨性融合。随访期间融合器位置及形态正常,内固定无断裂及滑脱。结论 应用小切口经腹膜外ALIF手术治疗复发性腰椎间盘突出症,创伤小,能够缓解患者症状及改善功能,脊柱融合率高,手术并发症少,近中期疗效满意。     

医用退热贴冷敷治疗产后生理性乳房胀痛的效果观察

目的 比较医用退热贴冷敷及卷心菜叶外敷2种方法对缓解产后生理性乳房胀痛的疗效.方法 选取2018年3-12月在产科住院的产后生理性乳房胀痛的患者100例为研究对象,将其随机分为对照组和观察组,各50例.对照组采用卷心菜叶外敷,观察组采用医用退热贴冷敷.结果 观察组产后生理性胀痛乳房评分低于对照组(Z=-2.568,P=...     

Construction of AP003469.4-miRNAs-mRNAs ceRNA network to reveal potential biomarkers for hepatocellular carcinoma

Studies have reported that the competing endogenous RNA (ceRNA) networks are related to disease progression and prognosis in patients with hepatocellular carcinoma (HCC). The roles and mechanisms of long-chain non-coding RNA AP003469.4 in HCC have remained unclear. Here, we explored the roles of AP003469.4 in HCC progression using bioinformatics, CCK-8, Transwell assay, etc. AP003469.4 targets miRNAs and these target genes were predicted by the LncBase Predicted v.2, miRDB, miRTarBase, and TargetScan databases. Then, AP003469.4-associated ceRNA network was constructed. Biological functions and mechanisms of differentially expressed genes in the ceRNA network were explored using GO and KEGG. Survival analysis and Cox regression analysis were used to screen prognostic genes and construct a prognostic risk model. The results revealed that AP003469.4, with the area under the curve of 0.9048, was highly expressed in HCC tissues. Increased expression of AP003469.4 was an independent risk factor for the dismal prognosis of HCC patients and was associated with the short overall and disease-free survival. Downregulation of AP003469.4 expression inhibited cell proliferation, cycle transition, invasion, and migration, and promoted cell apoptosis. There were 489 differentially expressed target genes in the ceRNA network, which were involved in several pathways, such as the MAPK signaling pathway, cell cycle, and p53 signaling pathway. The risk model was based on the DTYMK, ZFC3H1, CBX2, PKM, TTC26, ATG10, TAGLN2, CD3EAP, SHISA9, SLC1A5, KPNA2, SCML2, E2F7, and SMARCD1, which were the independent risk factors for poor prognosis of HCC patients. In general, interference with AP003469.4 expression might delay the progression of HCC. AP003469.4 related network could help to identify the hub target molecules in HCC progression, which might be candidate biomarkers for evaluating the prognosis of HCC patients.     

Endoscopic features of esophageal high-grade intraepithelial neoplasia dominated by cytological atypia

Little is known about esophageal high-grade intraepithelial neoplasia dominated by cytological atypia (HGINc). We aimed to elucidate the endoscopic features of HGINc compared with esophageal high-grade intraepithelial neoplasia dominated by architectural atypia (HGINa). All patients pathologically diagnosed as esophageal high-grade intraepithelial neoplasia after endoscopic submucosal dissection at our center between January 2018 and December 2019 were included in this study. According to the pathological diagnosis, the patients were divided into two groups: HGINa group and HGINc group. Basic characteristics and endoscopic information were collected in detail. Data were analyzed statistically. Binary logistic regression was performed and a predictive model for HGINc was established. Then we evaluated its predictive value and built a nomogram for clinical application. A total of 175 patients were included in this study (126 with HGINa and 49 with HGINc). Among 228 lesions found in all patients, there were 148 HGINa and 80 HGINc. The independent relevant factors for HGINc were tobacco and alcohol usage, color, and gross type. To predict risk of HGINc, a three-factor model (TFM) was established with a highest area under curve (AUC) as 0.869 (95% CI, 0.852, 0.939). When the cut-off value was set as 0.3569184, the diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for HGINc was 81.14%, 88.75%, 77.03%, 67.62%, and 92.68%, respectively. HGINc differs greatly in endoscopic features from HGINa in our study. It’s important to reduce misdiagnosis that our model was established with good predictive value for clinical application.     

甲状腺髓样癌不同手术方式对预后影响(附46例报告)

目的探讨甲状腺髓样癌(MTC)的不同手术方式的临床效果。方法对手术治疗的46例甲状腺髓样癌患者的临床资料进行回顾性分析,比较不同手术方式的治疗效果。结果首次手术行全甲状腺切除组甲状腺区复发率低于腺叶切除组,更低于肿瘤摘除组(P<0.05)。结论对MTC单侧病灶者,原发灶至少应行侧腺叶+峡部切除,最好行全甲状腺切除;无论N0或N1患者,颈淋巴结治疗均应考虑行同侧颈清扫,可不必行对侧预防性颈清扫。     

多发性大动脉炎的彩色多普勒超声诊断价值

目的探讨多发性大动脉炎的二维及彩色多普勒超声特征.方法回顾分析昆明医科大学附属延安医院影像科14例经临床证实的多发性大动脉炎患者周围血管和心脏的彩色多普勒超声影像资料.结果 (1)病变段动脉内膜-中层弥漫性增厚,回声偏低,管腔狭窄或闭塞,病变段与非病变段分界清晰,彩色多普勒显示相应的血流动力学改变;(2)受累心脏心腔增大,室壁增厚、运动减弱,左心室收缩、舒张功能减低.结论彩色多普勒超声可实时、准确、直观地显示多发性大动脉炎患者受累血管及心脏的病变性质、范围和程度,是临床诊断多发性大动脉炎的首选检查方法.     

巴马小型猪1型糖尿病模型胰腺病理及生化指标的变化

目的 探讨腹腔多次注射链脲佐菌素(STZ)对巴马小型猪糖尿病胰腺病理学及生化指标的影响,为糖尿病相关研究提供安全稳定的动物模型。方法 选用健康雄性巴马小型猪12只,分为正常对照组(n=6)和糖尿病模型组(n=6)。糖尿病模型组腹腔注射STZ,第一次腹腔注射STZ 75 mg/kg,1周后第二次腹腔注射STZ 150 mg/kg,正常对照组注射等量柠檬酸钠溶液,动态监测2组小型猪空腹血糖;实验结束后行葡萄糖耐量试验(OGTT)、胰岛素释放试验(IRT)及胰腺组织病理学检查、胰岛β细胞免疫组化染色分析。结果 ①糖尿病模型组所有小型猪均造模成功,成模后均表现多尿、多饮、多食及体质量减轻“三多一少”的症状;②自链脲佐菌素给药后13 d开始,糖尿病模型组空腹血糖明显升高并稳定在(7.6~17.1)mmol/L水平;③造模成功1周后,糖尿病模型组OGTT各时点血糖水平均高于正常对照组(P<0.01),IRT各时点胰岛素水平均低于正常对照组(P<0.01);④糖尿病模型组胰腺组织病理学检查结果显示,胰岛细胞团及胰岛β细胞数目明显减少;⑤胰岛β细胞免疫组化结果提示,糖尿病模型组胰岛中胰岛素染色阳性面积显著低于正常对照组[(10.68±2.78)% vs (43.63±2.83)%, P<0.01]。结论 采用腹腔多次注射STZ可成功构建巴马小型猪1型糖尿病(T1DM)模型,该方法操作简单、成模率高、安全性强,是比较理想的制备小型猪T1DM模型的造模方法。     

中文版心境障碍问卷在心境障碍患者中的应用

目的探讨中文版心境障碍问卷(MDQ-C)筛查双相障碍的可行性,对抑郁障碍患者中有双相障碍可能的患者进行临床特征分析。方法采用MDQ-C对308例心境障碍患者进行测评,包括双相障碍134例(双相障碍组)和抑郁障碍174例(抑郁障碍组)。对抑郁障碍组中MDQ得分≥5和MDQ得分<5的患者的临床特征进行比较分析。结果抑郁障碍组患者MDQ得分(3.90±2.92)明显低于双相障碍组(6.48±3.76),差异有统计学意义(t=6.574,P=0.000);抑郁障碍组MDQ得分≥5的患者比例(34.5%,60/174)也明显低于双相障碍组(64.9%,87/134),差异有统计学意义(χ2=28.121,P=0.000)。Logistic回归分析结果显示:MDQ得分≥5的抑郁障碍患者多为男性(优势比OR=0.342,P=0.004)和年龄<25岁(OR=0.952,P=0.001)患者,且首次发病存在食欲增强特征(OR=5.007,P=0.029)。结论抑郁障碍患者中未被识别的双相障碍比例较高,MDQ-C可作为筛查工具提高双相障碍的识别率。男性、年龄<25岁、首次发病存在食欲增强不典型特征的抑郁发作患者有潜在双相障碍的可能。     

黄芪对大鼠肾小球系膜细胞增生水平的影响

目的：探讨黄芪注射液(AM)对大鼠肾小球系膜细胞(GMCs)增生作用的影响。方法:实验分三组，空白对照组，脂多糖组(LPS)，综合组(LPS十AM)。采用MTT掺入方法，于24、48小时，观察三组GMCs增生水平。结果：综合组于48小时GMCs增生的抑制最为显著，且GMCs增生水平明显低于脂多糖组(P＜0．01)和空白对照组(P＜0．05)。结论：AM能抑制大鼠GMCs增生。     

病案资源的利用与电子病案

作者追踪了今年1-4月内外科住院病案的利用情况及现有的病案管理模式主要存在的问题;论述了电子病案的优势及PACS系统:提出了电子病历信息的法律问题、电子病历的使用权限、病案在HIS系统中的流动等几点思考.得出结论:充分利用现有的、具有全国先进水平的HIS和它拥有的巨大的信息资源库,是解决病案信息合理充分利用的根本途径.