Objective:To propose a model using the maximum intensity projection (MIP) of lung field computed tomography (CT) images and deep convolution neural network (CNN) and explore its value in identifying chronic obstructive pulmonary disease (COPD).Methods:A total of 201 subjects were selected from the Second Hospital of Dalian Medical University from January 2010 to May 2021. All subjects were included according to the inclusion criteria and were divided into COPD group (101 cases) and healthy controls group (100 cases). Each patient underwent a high-resolution CT scan of the chest and pulmonary function test. First, the lung field was extracted from CT images and the intrapulmonary MIP images were acquired. Second, with these MIP images as input, the model for identifying COPD was constructed based on a modified residual network (ResNet). Finally, the influence of the number of residual blocks on the performance of the models was investigated. Accuracy, sensitivity, specificity, positive predictive value, negative predictive value, receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the identification efficiency.Results:The accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of ResNet26 was 76.1%, 76.2%, 76.0%, 76.2%, and 76.0%, respectively; and the AUC of the test was 0.855 (95% CI: 0.799-0.901). The accuracy, sensitivity, specificity, PPV, NPV of ResNet50 was 77.6%, 76.2%, 79.0%, 78.6%, and 76.7%, respectively; and the AUC of the test was 0.854 (95% CI: 0.797-0.900). The accuracy, sensitivity, specificity, PPV, NPV of ResNet26d was 82.1%, 83.2%, 81.0%, 81.6%, and 82.7%, respectively; and the AUC of the test was 0.885 (95% CI: 0.830-0.926). Conclusions:The COPD identification model via MIP images from CT images within the lung and deep CNN is successfully constructed and achieves accurate COPD identification. And it can provide an effective tool for COPD screening.

目的 探讨持续个性化护理干预对扩张型心肌病患者生存质量和再住院率的影响.方法 56例扩张型心肌病患者随机分为两组,对照组给予常规专科护理干预,观察组在对照组基础上给予持续个性化护理干预,比较两组的干预效果.结果 出院后1年,观察组的生存质量各维度评分及综合评分均高于对照组(P<0.05).出院后1年内,观察组的再住院率低于对照组(P<0.05).结论 持续个性化护理干预可有效提高扩张型心肌病患者的生存质量,降低患者再住院率.

Objective:To investigate the significance and level of serum GRP78 and GRP94 in the early stage ofacute pulmonary embolism.Methods:Ninety APE patients (APE group) and forty healthy controls (control group) in Affiliated Zhongshan Hospital of Dalian University from January 2018 to March 2020 were recruited. The level of serum D-Dimer, GRP78 and GRP94 were compared between the two groups. The pulmonary embolism group was divided into three groups according to guidelines for the diagnosis and treatment of pulmonary embolism in ESC in 2019: low risk, medium risk, high risk, The level of serum D-Dimer, GRP78, GRP94, blood gas, pulmonary arterial pressure, PESI mark of three groups were compared.Results:Two groups had no significant difference in sex, age, body mass index ( P>0.05), but the level of serum D-Dimer, GRP78 and GRP94 in control group and APE group were higher than those in the control group: (3.86 ± 1.82) mg/L vs. (0.31 ± 0.15) mg/L, (2.68 ± 0.71) μg/L vs. (1.64 ± 0.38) μg/L, (1.31 ± 0.29) μg/L vs. (0.98 ± 0.13) μg/L ( P<0.05). The levels of serum D-Dimer, GRP78, GRP94, pulmonary arterial pressure, PO2, PESI score of different degree group (low risk, medium risk, high risk) were higher than those of low risk group and medium risk group: (5.63 ± 1.75) mg/L vs. (2.29 ± 0.51) and (3.64 ± 1.02) mg/L, (3.24 ± 0.76) μg/L vs. (2.17 ± 0.41) μg/L and (2.64 ± 0.47) μg/L, (1.57 ± 0.33) μg/L vs. (1.12 ± 0.13) and (1.26 ± 0.14) μg/L, (47.75 ± 6.98) mmHg (1 mmHg = 0.133 kPa) vs. (26.15 ± 4.63) and (35.21 ± 5.85) mmHg, (123.5 ± 20.59) scores vs. (85.5 ± 14.31) and (102.5 ± 13.32) scores ( P<0.05), and that of medium risk group were higher than those of low risk group ( P<0.05). But PO 2 of high risk group was lower than that of low risk group and medium risk group ( P<0.05), and PO 2 of medium risk group was lower than that of low risk group ( P< 0.05). pH of three group had no significant difference ( P>0.05). PCO 2 of high risk group was lower than that of low risk group and medium risk group ( P<0.05), and PCO 2 of medium risk group and low risk group had no significant difference ( P>0.05). The level of serum D-Dimer, GRP78, GRP94 were positively correlated withPESI score ( r = 0.610, 0.622, 0.627, P<0.01). After treatment, the levels of D-Dimer, GRP78 and GRP94 were significantly decreased ( P<0.05). Conclusions:The level of serum GRP78 and GRP94 are connected with acute pulmonary embolism, and it can reflect the severity of the disease.

目的 探讨XT-4000i血细胞分析仪体液模式下对脑脊液白细胞计数及分类计数中应用的可行性.方法 于2018年7～10月收集我院神经内科患者脑脊液标本46例.用XT-4000i血细胞分析仪体液模式对收集的脑脊液标本白细胞计数及分类计数的精密度、携带污染率、线性范围等进行性能验证评估,并将仪器法和手工计数法的白细胞计数及分类结果进行比较.结果 脑脊液白细胞总数计数精密度低、中、高值变异系数分别为1.92％、1.60％、1.45％;单个核细胞计数低、中、高值变异系数分别为4.31％、2.63％、2.73％;多形核细胞计数低、中、高值变异系数分别为3.00％、0.09％、1.59％.白细胞总数计数、单个核细胞计数、多形核细胞计数携带污染率分别为0.07％、0.64％、0.29％.脑脊液样本中,白细胞检测范围(0～10.06)×109/L,单个核细胞检测范围为(0～2.459)×109/L,多形核细胞检测范围为(0～7.60)×109/L,线性均良好.脑脊液白细胞计数及分类仪器法与人工法相关性良好,两种方法对白细胞计数及分类的差异无统计学意义(>0.05).结论 应用XT-4000i血细胞分析仪体液模式下的白细胞计数及分类精密度良好,携带污染率低,线性良好,与人工镜检法相关性良好,可用于人工镜检应用于脑脊液白细胞计数及分类.

Objective:The personnel composition factors and impact which influenced research performance of clinic departments were explored, to optimize personnel structure for further references on enhance the hospital scientific achievements.Methods:The research performance scores and personnel overall composition of 75 clinic departments in the year of 2017 were retrospectively analyzed. Principal component regression was used to analyze the correlation between research performance and personnel composition.Results:KMO was 0.635, P<0.001, the model had statistical significance. Four common factors identified were: middle-age females, young masters, senior master supervisors and doctors & doctoral supervisors. Accumulative variance contribution rate was 87.19%. After reducing equations, doctor degrees ( β=124.164), intermediate professional title ( β=123.573), Age≥40 ( β=102.149) and doctoral supervisors ( β=95.309) were four most influential factors on research performance of clinic departments. Conclusions:The selection of common factors should be comprehensively considered, combining with multiple criterions and professional significance. A team structure based on middle-aged and young people led by doctoral supervisors, and with backbones of doctoral degree personnel will help to improve the scientific research performance of clinical departments.

从供给侧角度探索高校思政课教学正在成为思政工作改革的热点,思政课教师队伍建设则是供给侧改革中的关键,首先要发挥供给侧——思政课教师的主导作用,保证思政课教师数量充足、素质优良,才能引导需求侧——学生发挥其主体作用.

创新的关键在于人才,而创新人才的培养主要靠教育.本研究通过互联网+教育对创新人才培养存在的问题、具体措施等的研究,对高校创新人才的培养有着重要的现实意义.

目的:探讨胸腺素β4 (Tβ4)在老年晚期非小细胞肺癌(NSCLC)中的表达与临床病理学因素及一线含铂类化疗疗效的关系.方法:选取94例晚期的老年NSCLC患者病理组织标本,采用免疫组化的方法检测Tβ4的表达水平,分析临床病理特征,采用实体瘤客观疗效评价标准(RECIST)评价化疗效果,进行生存随访.分析Tβ4的阳性表达与无进展生存期(PFS)及总生存期(OS)的关系.结果:在94例老年晚期NSCLC患者中,Tβ4的高表达率为39.4％(37例/94例).相关性分析表明,Tβ4的高表达与性别、分化程度、病理类型、TNM分期、化疗方案及T分期等因素无关(P＜0.05),与化疗疗效(r=0.327,P=0.001)、PFS(r=0.387,P=0.002)及OS(r=0.404,P=0.001)显著相关.多因素Logistic回归分析表明,Tβ4表达为NSCLC患者疗效的影响因素(P＜0.05).COX多因素分析表明Tβ4表达水平是化疗反应率及PFS的预测因素(P＜0.05).结论:Tβ4的高表达与老年晚期NSCLC一线含铂化疗疗效及生存期相关.Tβ4对于老年晚期NSCLC一线含铂化疗方案的疗效预测具有一定的临床意义.

Objective:To explore the combination of study abroad and scientific research effectiveness, improve the " effectiveness concern" related to the selection mechanism for abroad-study, establish an evaluation system combined studying abroad and scientific research effectiveness.Methods:The research was based on 45 local-funded abroad-study programs, and used path analysis to connect main influence factors of studying abroad with scientific achievements, and establish a model.Results:The final path analysis model contained two regression equations: (1) in the equation of SCI articles, adjusted R2=0.600, F=5.698, P<0.001, statistic difference was significant. In this pathway, influence factors on SCI articles were successively Professional Title ( β=0.736, P<0.001), Age ( β=-0.700, P<0.001) and foreign institutions ( β=-0.318, P=0.031); (2) in the equation of Project funding, adjusted R2=0.490, F=7.608, P<0.001, statistic difference was significant. In this pathway, influence factors on project funding were successively SCI Articles ( β=0.409, P=0.010), Study country ( β=-0.342, P=0.015), and Degree ( β=-0.223, P=0.043). Conclusions:According to the path analysis, impacts of studying abroad on scientific research effectiveness were evaluated and detailed more precisely. The research established scientific-effectiveness oriented pathway between assigning and evaluation system, providing support to promote effectiveness of hospital abroad-study scientific outputs, and provide possible reference for local and national governments to optimize international exchange programs.

In 2015, the state has started the reform of postgraduation in medical specialty training.The training of postgraduates of medical specialty is carried out simultaneously with the standardization training of resident physicians.This system of training has improved the standardization of medical personnel training and makes full use of the medical and educational resources available.It is a crucial and inevitable requirement in meeting social needs and the development of graduate education.Based on the practice of the reform of Dalian Medical University, this paper expounds the existing and the management of clinical base in postgraduates, and explores the problems such as the curriculum system, clinical training and the role of mentor effective ways to improve the quality of postgraduates in medical specialty.

Objective:To investigate the effects of low-dose azithromycin on lung function and exhaled nitric oxide concentration in bronchial asthma.Method:58 patients with newly diagnosed asthma were selected in respiration department in 2012,they were randomly divided into the azithromycin group and the control group,29 cases in each group. The azithromycin group was treated with azithromycin combined with inhaled Salmeterol xinafoate and fluticasone propionate powder for inhalation,the control group was only treated with salmeterol xinafoate and fluticasone propionate powder, ventolin inhalation were applied when necessary,the FEV1,PEF and the level of FeNO between the two groups were observed and compared.Result:The FEV1,PEF and the level of FeNO of two groups before treatment,the differences had no statistical significance(P>0.05).FEV1 and PEF levels after treatment in the two groups were significantly higher than those before treatment,and the FEV1 and PEF levels in azithromycin group after treatment were significantly higher than those in control group,the differences were statistically significant(P<0.05).The level of FeNO after treatment in the two groups were significantly lower than the control group,and the level of FeNO in azithromycin group after treatment was significantly lower than the control group,the differences were statistically significant(P<0.05).Conclusion:Asthmatic patients treated with low-dose azithromycin combined with salmeterol xinafoate and fluticasone propionate powder have better therapeutic effects,it is worthy of clinical promotion.

隐源性机化性肺炎（ cryptogenicorganizing pneumonia ， COP ）为特发性间质性肺炎（ idiopathic interstitial pneumonia ， IIP ）的7个亚型之一，临床少见，对糖皮质激素治疗反应良好，甚至可以获得完全缓解。但临床诊断相对困难，下面就我院诊治的20例COP患者的诊断与治疗过程作一综合分析。<br>　　一、资料和方法<br>　　1．一般资料：收集我院2009年1月至2011年11月住院的COP患者20例，男11例，女9例，年龄23～83岁，平均61.3岁，病程1～20个月。20例中除伴有席汉综合征及早产（孕28周）各1例外，其余18例均无明确的继发性COP依据。患者最短复查间隔时间为3 d，最长3.5个月；随访最短时间为9个月，最长43个月。急性起病5例，并2例出现急性呼吸窘迫综合征，其余为亚急性或缓慢发病，从出现症状到明确诊断的时间为1～3个周。主要症状以咳嗽（20例，其中16例为干咳）为主，乏力（20例）、活动后气急（14例）、呼吸困难（10例），少数患者咳少量白痰（3例），或出现中度发热（8例）、体重减轻（2例）、周身不适（20例）等。20例患者均可闻及爆裂音（velcro音），多出现于两肺中、下部，其中4例有发绀；肺功能示限制性通气功能障碍，弥散功能明显减低。

Objective To investigate the effect of zerumbone on migration,invasion and related gene expression of human pancreatic cancer cell lines BxPC-3 and Panc-1.Methods Human pancreatic cancer cell lines BxPC-3 and Panc-1 were selected as the object for investigation.Methyl thiazolyl tetrazolium(MTT) assay was performed for choosing the appropriate concentration of zerumbone.Cell scratch test,transwell migration assay and invasion experiment were performed to assess the effect of zerumbone on cell migration and invasion.The expression levels of CXC chemokine receptor 4(CXCR4),mitogen-activated protein kinase(MEK)1/2,extracellular-signal-regulated kinase(ERK)1/2,phosphorylated MEK1/2(p-MEK1/2),phosphorylated ERK1/2(p-ERK1/2) were measured by Western blot.Results Zerumbone could inhibit the proliferation of BxPC-3 and Panc-1 cells in a dose-and time-dependent manner(P<0.05).Cell scratch test showed that the migration rates of BxPC-3 and Panc-1 cell after zerumbone treatment were lower than those of the control group(P<0.05).The average number of migration and invasive cells was fewer in zerumbone treatment group than that in control group(P<0.05).Western blot assay showed that zerumbone reduced the expression of CXCR4,p-MEK1/2 and p-ERK1/2.Conclusions Zerumbone could inhibit the migration and invasion of human pancreatic cancer cell lines BxPC-3 and Panc-1.This might be related to the down-regulation of expression of CXCR4,p-MEK1/2,p-ERK1/2,and this may provide a new insight for the tumor targeted therapy.

Obsjective To investigate the relationship of the high expression of sorcin with multidrug resistance in lung cancer cell NCI- H446. Methods Lung cancer cell NCI- H446 was object of study,set up cell line NCI- H446 / CDDP through cisplatin; Using antisense nucleic acid technology inhibited the expression of sorcin in NCI- H446 / CDDP cell,building antisense nucleic acid group,at same time setting up blank control group. RT- PCR and Western- blot were used to analyze the expression of sorcin at mRNA and protein levels in every cell group. MTT was used to three groups cell( NCI- H446 cell group,antisense nucleic acid group,NCI- H446/CDDP group) survival rate in DDP,VCR,ADM,VP- 16. Pearson correlation was used to analyze the correlation of the high expression of sorcin with multidrug resistance in lung cancer cell NCI- H446. Results Comparison with the expression mRNA and protein of sorcin in every groups,the result showed: comparing NCI- H446 / CDDP group with blank control group has no statistical significance( P > 0. 05),Intercomparison in NCI- H446 cell group,antisense nucleic acid group,NCI- H446 / CDDP group has statistical significance( P <0. 05). The expression mRNA and protein of sorcin in NCI- H446/CDDP were obviously higher than it in NCI-H446 cell,9. 81 and 7. 67 times respectively. The result of IC50: NCI- H446 / CDDP group > antisense nucleic acid group > NCI- H446 cell group,has statistical significance( P < 0. 05). Pearson correlation to point out: the expression of sorcin in mRNA and protein was negatively correlated to IC50of the group cells in different chemotherapy drugs. Conclusion The high expression of sorcin is related to multidrug resistance in lung cancer cell,Inhibition of its expression can reverse the drug resistance of lung cancer.

如何加强和改进医学研究生党建工作,体现党支部的战斗堡垒作用,发挥党员在广大研究生中的先进性,是目前医学研究生党建工作研究的热点问题之一。

Objective To investigate the diagnosis,treatment and prognosis of Cryptogenic Organizing Pneumonia(COP).Methods Clinical and imaging features,treatment and prognosis of 12 COP patients admitted to our hospital from January 2009 to June 2011 were retrospectively analyzed.Results(1)12 cases with COP syndrome were diagnosed in which cough(in 12 cases),weakness(in 12 cases),fever(in 11 cases) and dyspnea(in 9 cases) were the major symptoms,and Velcro sounds could be heard in the two sides of the lungs.(2)Nodular and patchy shadows under the pleura and around bronchus could be seen in the CT or HRCT scan in 4 cases;multiple patchy and linear shadows under the pleura and around bronchus including air bronchogram can be seen in 3 cases;patchy ground-glass opacity under the pleura and around bronchus can be seen in 2 cases;ground-glass opacity and reticular shadows and interlobular septum thickening under the pleura,even forming paving stone in 1 case;ground-glass opacity and reticular and linear shadows under the pleura can be seen in 1 case and multiple patchy and linear shadows under the pleura like migrating in 1 case.(3)After the treatment with methylprednisolone 40~160 milligram/d for 3~14 days,then patients were given oral prednisone 30~40 milligram/d.The CT or HRCT manifestations were improved distinctly after the treatment of glucocorticoids.The patients were improved or cured after 4 to 12 months treatment.The 2 to 20 months following up showed that 9 cases were cured and 3 cases were improved.Conclusion The clinical and radiological manifestations of COP are usually polymorphic,multi-occurrence,multivariant and bilateral lungs affected,but honeycomb lung is rarely seen.The COP can be diagnosed according to clinical and HRCT features without Histology evidences.The reaction of COP to the treatment of glucocorticoids is good,and sometimes it can be even cured.CT scan is of good indication for prognosis.

目的 利用支气管肺泡灌洗法检测头孢他啶在兔肺组织中的渗透性.方法 静脉注射头孢他啶后于不同时间采集血及肺泡间质液(ELF)标本.绘制血及ELF中头孢他啶的药-时曲线,计算肺组织的渗透率.结果 头孢他啶在兔血清和肺组织中的药物浓度相对稳定,兔肺组织的渗透率为(74.08±11.02)%.结论 支气管肺泡灌洗法检测肺组织的渗透性安全可靠.

OBJECTIVE:To study the levels of serum interleukin (IL)-18 and IL-33 in asthmatic patients pre-and post-treatment with glucocorticoids during the acute exacerbation period and therefore to investigate the role of IL-18 and IL-33 in the pathogenesis of bronchial asthma.METHODS:Thirty cases of moderate to severe asthma admitted in the Second Affiliated Hospital of Dalian Medical University from June, 2009 to October, 2010 were chosen as the asthma group, and 23 healthy people who underwent routine physical examination were chosen as the control group. The subjects in the 2 groups were all nonsmokers. All the patients were treated with a glucocorticoid (methylprednisolone 40 - 80 mg/d) for 3 to 5 days and combined with aerosol inhalation of budesonide for 1 to 2 weeks as adjuvant therapy. The serum levels of IL-18 and IL-33 were detected for the asthma group before and after the treatment and for the control group. Other data including immunoglobulin E (IgE), the number of eosinophil cells (EOS) and the pulmonary function (FEV(1)%pre) were measured as well. The differences of IL-18 and IL-33 levels between the asthma group before and after treatment and the control group were analyzed, and the correlation between IL-18, IL-33 and IgE, EOS and FEV(1)%pre were analyzed as well by SPSS software.RESULTS:Compared with the healthy control group [(158 ± 45) ng/L and (143 ± 32) ng/L], the levels of IL-18 and IL-33 in the asthma pre-treatment group were significantly increased [(300 ± 181) ng/L and (208 ± 95) ng/L, t = 3.67 and 3.51, all P < 0.05)]; and the IgE level and EOS count showed a similar change (t = 5.76 and 5.24, all P < 0.05). After systemic glucocorticoid treatment and local aerosol inhalation, the levels of IL-18 and IL-33 [(183 ± 83) ng/L and (148 ± 77) ng/L] were decreased significantly in the asthma patients [t = 5.42 and 12.09, all P < 0.05], and the IgE level and EOS count also showed a same trend as well (t = 11.87 and 4.56, all P < 0.05), whereas FEV(1)%pred [(54 ± 14)%] increased significantly [(81 ± 16)%, t = -7.81, P < 0.05]. The Pearson correlative analysis showed that there were positive correlations between the levels of IL-18, IL-33 and IgE and EOS, respectively (all P < 0.05), and there were negative correlations between IL-18, IL-33 levels and FEV(1)%pre, respectively (all P < 0.05).CONCLUSIONS:Our results suggest that IL-18 and IL-33 participate in the pathogenesis of asthma, and may play stimulation role in the process of the disease.

[Objective] To examine the influence of subchronic exposure to arsenic(As) on expressions of Eif2s3y in the brain of mice.[Methods] Thirty mice were divided into 3 groups of 10 each.The mice in Group 1 received drinking water alone(control).The mice in Group 2 and 3 received 1 and 4 mg/L arsenic trioxide by drinking water,respectively.On the 60th day after As exposure,mice were decapitated and their brains were removed.Expression of Eif2s3y was examined in the brain of mice exposed to As with genechip and RT-PCR.[Results] Compared to control group,the mRNA expressions of Eif2s3y in cerebral cortex and medullary substance increased significantly in the experimental groups.[Conclusion] These results indicated that subchronic exposure to As may up-regulate expression of Eif2s3y in the cerebral tissue of mice.

OBJECTIVE:To compare PPD conversion with γ-interferon release assay (IGRA) in determining the newly Mycobacterium tuberculosis (MTB) infection during a TB outbreak.METHODS:The 505 subjects exposed to a TB outbreak were divided into 3 groups based upon the induration diameters of PPD before the outbreak. The changes of PPD induration diameters were observed in different groups, and correlation between PPD conversion or IGRA and exposure levels were analyzed by logistic regression.RESULTS:In subjects with the highest exposure level, the increase in induration of PPD was (12 ± 5) mm, (7 ± 4) mm, and (5 ± 3) mm respectively among the previous PPD < 5 mm, 5 - < 10 mm, and ≥ 10 mm groups, the difference being significant among groups, χ(2) = 43.12, P < 0.01. Using logistic regression analysis, PPD conversion was related to the exposure level (OR = 4.70, P < 0.05) only in the PPD < 5 mm group, while IGRA positivity was closely related to the exposure levels in all 3 groups (OR values were 2.16 - 3.60, P < 0.05). In the high exposure group, the subjects with IGRA positivity combined with PPD conversion rate was 26.1% (31/119), and the subjects with IGRA positivity but no PPD conversion rate was 39.5% (47/119), while in the low exposure group the results were 6.5% (12/185) and 16.8% (31/185) respectively, the difference being significant (χ(2) = 22.82 and 19.63, P < 0.01). After 1 year of follow-up, the reversion rate of the subjects with IGRA positivity was 48.1% (91/189), while the mean increase value of PPD was (1.1 ± 4.0) mm.CONCLUSION:IGRA is superior to PPD conversion in the diagnosis of tuberculosis infection, and more valuable in the detection of newly infected cases.