Objective:To evaluate rapid on-site evaluation (ROSE) in endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for pancreatic solid lesions, and to compare the difference in ROSE performance between cytopathologists and trained endoscopists.Methods:A total of 168 consecutive patients with pancreatic solid lesions who underwent EUS-FNA from January 2014 to December 2020 at Fuding Hospital, Fujian University of Traditional Chinese Medicine were recruited. The patients who did not receive ROSE from January 2014 to November 2017 were included in N-ROSE group ( n=67). Since December 2017, the patients who intended to receive EUS-FNA were divided into E-ROSE group ( n=59, patients who received EUS-FNA and ROSE by endoscopists trained with cytopathology) and C-ROSE group ( n=42,patients who received EUS-FNA by untrained endoscopists and ROSE by cytopathologists) according to random number table. The number of punctures, sample adequacy, cytological diagnosis, final diagnosis and diagnostic efficiency (including the sensitivity, the specificity, the positive predictive value, the negative predictive value and the accuracy) in 3 groups were compared. Results:(1) The puncture number in N-ROSE group (4.22±0.76) was significantly more than E-ROSE group (3.12±0.79, P<0.001) and C-ROSE group (3.24±0.91, P<0.001). (2) The proportions of adequate samples in N-ROSE group [82.09% (55/67)] was significantly lower than those of E-ROSE group [96.61% (57/59), χ2=5.308, P=0.021] and C-ROSE group [97.62% (41/42), χ2=4.541, P=0.033]. The proportion of negative cytological diagnosis in N-ROSE group [40.30% (27/67)] was significantly higher than those of E-ROSE group [20.34% (12/59), χ2=5.848, P=0.016] and C-ROSE group [19.05% (8/42), χ2=5.348, P=0.021]. (3) The sensitivity of N-ROSE group [74.07% (40/54)] was significantly lower than those of E-ROSE group [94.00% (47/50), χ2=6.151, P=0.013] and C-ROSE group [94.44% (34/36), χ2=4.817, P=0.028]. The accuracy in N-ROSE group [79.10% (53/67)] was significantly lower than those of E-ROSE group [94.92% (56/59), χ2=5.433, P=0.020] and C-ROSE group [95.24% (40/42), χ2=4.155, P=0.042]. (4) There was no significant difference in any observational index between E-ROSE group and C-ROSE group ( P>0.05). Conclusion:ROSE in EUS-FNA can improve sample adequacy, the diagnostic sensitivity and accuracy, and reduce the number of punctures. The sample adequacy and diagnostic efficiency of endoscopists trained with cytopathology are comparable to those of cytopathologists.

[目的]总结近年来静息态脑功能磁共振成像(resting state-functional magnetic resonance imaging,rs-fMRI)在针刺干预慢性颈痛中的研究进展.[方法]以"慢性颈痛""针刺""fMRI"为检索词,通过中国知网、万方、PubMed等数据库检索近5年来国内外针刺干预慢性颈痛的rs-fMRI的研究文献,分析针刺对慢性颈痛患者脑功能调节特点.[结果]岛叶、前扣带回、前额皮质、杏仁核等"疼痛矩阵"的脑功能改变与慢性颈痛的发生与情绪体验密切相关.岛叶、前扣带回、前额皮质、杏仁核、中脑导水管周围灰质等功能核团是针刺缓解慢性颈痛疼痛程度及改善负性情绪的关键脑区.[结论]针刺通过调节慢性颈痛相关的感觉-情感-认知相关的脑功能区发挥治疗作用,利用rs-fMRI观察治疗前后关键脑区的信号变化及功能连接,不仅能够客观评价针灸治疗慢性颈痛的临床疗效,还能进一步探究其神经影像学机制,有望为后续制定个体化治疗方案、提高临床疗效提供新的思路与手段.

目的 探讨腰椎间盘突出症患者的椎旁肌面积及T2WI信号强度变化,为腰椎间盘突出症的评估及康复治疗提供参考.方法 收集43例L4-5椎间盘突出患者、45例腰椎间盘正常体检者,采用GE/HDXT/1.5T T2WI序列分别测量L4-5中心层面双侧椎旁肌(多裂肌、竖脊肌、腰大肌)横截面积、T2WI信号强度,比较椎间盘突出组和正常组在椎旁肌横截面积、T2WI信号强度的差异,组间采用两独立样本t检验、组内采用配对样本t检验.结果 腰突组和正常组比较,L4-5右侧多裂肌T2WI信号强度比值、右侧竖脊肌T2WI信号强度比值差异有统计学意义(P<0.05);椎旁肌横截面积及T2WI信号强度绝对值差异无统计学意义(P>0.05);43例腰突组组内比较,L4-5两侧竖脊肌面积、两侧多裂肌T2WI信号强度比值、两侧竖脊肌T2WI信号强度比值差异有统计学意义(P<0.05);17例旁中央型腰突组内比较,腰突侧与非腰突侧的椎旁肌横截面积、T2WI信号强度比值差异无统计学意义(P>0.05).结论 腰椎多裂肌、竖脊肌T2WI信号强度可为腰椎间盘突出症的评估及康复治疗提供参考.

慢性颈痛(chronic neck pain,CNP)是指由颈椎病[1]引起的症状持续>3个月的颈部疼痛,在影像学上通常表现为颈椎曲度变直和(或)椎小关节增生等退行性改变[2],临床上主要表现为头颈部活动受限、僵硬、上肢酸痛麻痹,手部无力以及肌肉收缩等,常伴发焦虑、抑郁、情绪低落等情绪障碍,不仅严重影响患者的生活质量,甚至还会给家庭和社会经济造成沉重的负担.根据国外流行病学调查显示[3],全球CNP的年龄标准化患病率是3551.1/10万.近年来,随着手机、电脑等电子设备的广泛普及,CNP发病率逐年升高,且发病年龄趋于年轻[4].有证据显示,>50％人可能从急性颈痛迁延为CNP,而高龄、女性、长期伏案工作及紧张焦虑等被认为是导致颈痛病程迁延的主要危险因素[5-6].因此,对CNP的临床诊断及合理干预具有重要性及急迫性.

The pathogenesis, clinical manifestations and pathological changes of diabetes nephropathy（DN） are related to the collateral disease theory of traditional Chinese medicine. In recent years, treatment and study of DN based on collateral diseases theory has gradually become a trend. Combined with literature, clinical experience and fundamental research, it is summarized that the core pathogenesis of DN is deficiency and stasis of collateral, the treatment method is to tonify deficiency for removing obstruction. It is believed that qi and blood should be taken as the key points in tonifying deficiency, and the difference between unblocking collaterals and removing blood stasis should be emphasized. The prescriptions should attach importance to strengthening healthy energy and Xinrun Tongluo herbs, and pay attention to slow attack and smooth collaterals. This paper expounds the pathogenesis and progress of DN from the theory of ‘collateral invasion in chronic sickness’, and discusses the current situation and thinking of treating DN from collaterals, with a view to providing reference for the prevention and treatment of DN.

Objective To investigate the diagnostic value of blue light imaging-bright (BLI-bright) and linked color imaging (LCI) for early esophageal cancer (EEC).Methods:Data of 63 consecutive patients with EEC who underwent gastroscopy under BLI-bright, LCI and white-light imaging (WLI) and endoscopic submucosal dissection (ESD) from May 2018 to August 2020 at Fuding Hospital Affiliated to Fujian University of Traditional Chinese Medicine were analyzed retrospectively in the cohort study. Subjective visibility analysis was performed by 6 endoscopists who were divided into 2 groups (expert group and trainee group) with 3 endoscopists in each group. The main observation index was the visibility score (ranking score, RS). The objective color difference (Δ E) between lesions of EEC and surrounding mucosa under 3 modes were analyzed by using the L *a *b * color space. Results:The overall RS of 6 endoscopists under WLI mode (2.57±0.81) was significantly lower than that under LCI (3.25±0.67) ( t=9.71, P<0.001) and BLI-bright (3.18±0.67) ( t=9.31, P<0.001). In the expert group, the RS of WLI (2.71±0.80) was significantly lower than that of LCI (3.33±0.66) ( t=7.16, P<0.001) and BLI-bright (3.42±0.62) ( t=8.09, P<0.001). In the trainee group, the RS of WLI (2.40±0.90) was also significantly lower than that of LCI (3.15±0.83) ( t=9.62, P<0.001) and BLI-bright (2.89±0.92) ( t=5.69, P<0.001), and the RS of LCI was higher than that of BLI-bright ( t=4.07, P<0.001). The Δ E between lesions of EEC and surrounding mucosa under WLI (11.52±3.40) was significantly lower than that under LCI (16.64±4.70) ( t=7.10, P<0.001) and BLI-bright (15.72±3.84) ( t=7.88, P<0.001). Conclusion:BLI-bright and LCI can effectively improve EEC visibility and color difference between EEC and surrounding mucosa. Furthermore, LCI is more conducive to the detection of EEC for the trainees.

对近年来糖尿病肾病从络病论治的临床研究及基础研究进行综述、分析和讨论,发现目前中医对糖尿病肾病的络病治疗以补虚通络法为主要原则,基础研究显示其作用机制主要与改善氧化应激和内质网应激、减轻炎症反应、改善微循环障碍和血管内皮损伤及减轻肾脏损伤有关.中医络病理论可为糖尿病肾病的临床和基础研究提供更多思路,也在临床运用中显示出一定优势.但目前补虚通络法的临床运用以补虚药物与化瘀药物的联合使用为主,而血瘀证与络病虽有重叠但并非同一范畴,因此当前糖尿病肾病的络病辨治未能结合络脉自身病变与主要致病因素及继发病机变化进行更有针对性的分期辨治,未能充分重视辛味药、藤类药及虫类药等经典络药的对证使用.此外,糖尿病肾病治络方药的基础研究缺乏与临床症状与实验室指标的关联分析.据此,倡导中医络病理论指导下更具体系的糖尿病肾病研究,进一步探索糖尿病肾病的络病实质,强调络药和微观辨证在糖尿病肾病靶药筛选过程中的重要性,探索糖尿病肾病中络药发挥作用的可能机制,以期为进一步推动络病理论和治络方药在糖尿病肾病的临床运用提供依据.

慢性疼痛作为一种常见病症,因其病因复杂、反复发作、疗效难以持久,严重影响患者身心健康[1-2].准确的疼痛测量有助于早期诊断、病情进展监测和疗效评价,是提高慢性疼痛治疗疗效的关键.基于功能磁共振成像技术(fMRI)的相关研究证明,疼痛可致大脑血流动力学发生改变,量化分析变化数据,并与患者自我报告的疼痛程度相对照,可客观评价患者的临床疼痛状态,从而为疗效评估提供参考依据.

目的:探讨迷你临床演练测评量表(Mini-CEX)在床边教学考核评估中的应用及效果.方法:选取附属二院进行床边教学的学生随机分为实验组和对照组,每组各20名.教师按照Mini-CEX考核量表对实验组学生进行每周两次的评价,并做反馈辅导;对照组学生仅采用理论授课与课间带教相结合的方式进行教学.学期末,对全部学生进行理论考核及Mini-CEX测评,并收集测评成绩进行对比分析,最后通过调查问卷的形式由学生及老师评价Mini-CEX评估中各项目的满意度.结果:学期末,两组学生在理论成绩和Mini-CEX各项评分均显著高于学期前,且实验组Mini-CEX各项目得分显著高于对照组,差异有统计学意义(P<0.05).结论:在床边教学中应用Mini-C E X评价表考核评估学生的平时临床实践表现,有助于提高床边教学质量,提高教师和学生对床边教学的积极性.

目的 从蛋白激酶R样内质网激酶（proteinkinaseR-likeendoplasmicreticulumkinase,PERK）-真核细胞起始因子2α（eukaryotic initiation factor 2α,eIF2α）-核因子κB（nuclear factor kappa B,NF-κB）信号通路角度观察甘草酸苷（glycyrrhizin,GL）对肠上皮细胞（intestinal epithelial cells,IECs）的保护作用，并探讨其治疗溃疡性结肠炎（ulcerative colitis,UC）的可能作用机制。方法 体外培养并通过免疫荧光法鉴定小鼠IECs,H2O2刺激法建立细胞内质网应激模型，GL组于造模同时给予不同剂量的GL干预。采用CCK8法检测细胞的存活率；流式细胞术检测细胞的凋亡水平；细胞跨膜电阻抗和异硫氰酸荧光素标记的右旋糖酐（fluoresceinisothiocyanate-dextran,FITC-dextran）法共同明确细胞屏障的通透性；Western blotting检测细胞中PERK-eIF2α-NF-κB通路核心蛋白的表达水平。结果 与模型对照组相比，GL中、高剂量组的存活率均升高（P＜0.05或P＜0.01），凋亡率均下降（P＜0.05或P＜0.01）;GL各剂量组单层膜细胞的细胞跨膜电阻抗值均显著升高（P＜0.01）、FITC-dextran浓度均显著下降（P＜0.01）,p-PERK、p-eIF2α和NF-κB蛋白的水平均下降（P＜0.05或P＜0.01）。结论GL通过抑制PERK-eIF2α-NF-κB信号通路的活化，从而提高小鼠体外细胞内质网应激状态下IECs的存活率，降低其凋亡水平，并改善细胞屏障的通透性，这可能是GL保护IECs、治疗UC的部分作用机制。

Purpose: This study was conducted to explore the diagnostic value of arterial spin labeling (ASL) combined with diffusion weighted imaging (DWI) in characterizing the spatiotemporal progression of infarct lesions in a rabbit middle cerebral artery occlusion (MCAO) model and predicting the acute cerebral infarction (ACI) volume. Materials and methods: Forty-two male rabbits (2.9 +/- 0.2 kg body weight) were used in this experimental study. Animals were initially anesthetized by intravenous injection of uratan. There were seven experimental groups with six rabbits in each group. The apparent diffusion coefficient (ADC) and cerebral blood flow (CBF) thresholds were established in the control group (n = 6), which were sacrificed at 12 h, stained for infarct volume, and imaged at each time point. Results: The normal ADC and CBF were estimated as 0.90 +/- 0.03 x 10(-3) mm(2)/s and 0.68 +/- 0.06 mL g(-1) min(-1), respectively. The viability thresholds of ADC and CBF yielding the lesion volumes (LVs) at 3 h, which best approximated the 2,3,5-triphenyltetrazolium chloride (TTC) infarct volumes at 12 h, were 0.52 +/- 0.02 x 10(-3) mm(2)/s (42.2 +/- 3% reduction) and 0.33 +/- 0.09 mL g(-1) min(-1) (51.0 +/- 11% reduction), respectively. The temporal evolution of the ADC- and CBF-defined LVs showed a significant perfusion/diffusion mismatch up to 1 h (p = 0.001). Conclusion: ADC values and ACI volumes were positively correlated, while CBF was negatively correlated, which is supposed to be a reference for predicting ACI volume.

目的:探讨运脾和络方对2型糖尿病(T2DM)大鼠骨骼肌脂肪异位沉积的影响.方法:采用高脂饲料喂养ZDF大鼠建立T2DM模型,将大鼠随机分为模型组和运脾和络组,另设正常组普通饲料喂养.干预10周后检测各组大鼠体质量、空腹血糖及脂质含量,观察各组大鼠骨骼肌病理改变,并运用多维质谱“鸟枪法”脂质组学技术进一步进行模式判别,分析各组大鼠骨骼肌脂质代谢的变化,筛选潜在生物标记物并进行代谢物网络分析.结果:与正常组比较,模型组大鼠体质量增加,血糖升高,脂质含量升高(P＜0.01,P＜0.05),病理观察显示脂肪沉积;与模型组比较,运脾和络组大鼠体质量减轻,血糖下降,脂质含量有不同程度下降,病理观察显示脂肪沉积改善.脂质组学通过采用有监督式方法OPLS-DA进行建模分析,筛选并鉴定出14个生物标记物,运脾和络可回调各生物标记物的异常改变.结论:运脾和络方可改善T2DM大鼠骨骼肌脂肪异位沉积,其机制可能与改善骨骼肌线粒体功能和调节脂肪酸代谢及磷脂代谢有关.

《2019AHA/ACC/H RS心房颤动病人管理指南更新》是针对2014年心房颤动指南发布以来出现的新证据而做出的修订.此次更新的范围包括心房颤动抗凝部分、心房颤动导管射频消融部分、急性冠脉综合征合并心房颤动的治疗部分以及新增的器械检测和减重部分.针对此次更新的内容进行汇总,并附上相关循证证据,以期对指南更新获得更加全面的认识.

哮喘发作有24小时缓冲期 一般来说,哮喘并不是一个突然性发作后直接导致死亡的疾病.而造成死亡的哮喘,多数由于合并其他疾病所致.在正常情况下,哮喘发作后大约半小时或以上,憋气、喘息或呼吸困难的症状会自主缓解. 哮喘发作时,气管会出现痉挛,但气管中的软骨也能帮助人体保持呼吸,吸入氧气.因此,对于单纯性的哮喘,若急性发作后,患者仍有24小时的缓冲时间,可前往医院寻求帮助.若哮喘发作且身边没有急救药物,应该在病情稍作缓解后,马上前往医院就诊治疗.

Objective:To evaluate the efficacy of linked color imaging (LCI) for the colorectal polyp detection, especially detection of adenoma.Methods:A retrospective analysis was conducted on the patients who underwent LCI or white light imaging(WLI) mode of LASEREO colonoscopy from May 2018 to March 2019.The differences of the detection rates in the global polyps, adenomatous polyps, flat polyps, small polyps (≤5 mm) and right-sided polyps under two modes were compared. Color differences between the adenomatous polyps and surrounding mucosa (ΔE) were examined under two modes, based on L *a *b * color space by the Commission Internationale de L′Eclairage in 1976. Results:The global polyp detection rate, especially adenoma detection rate, in LCI group was higher than that in WLI group(45.53% VS 32.83%, P=0.038; 53.65% VS 39.62%, P=0.009). The color difference(ΔE) between adenomatous polyps and surrounding mucosa in LCI group was significantly higher than that in WLI group(27.24±8.67 VS 15.28±6.68, P<0.001). In addition, the detection rates of flat polyps, small polyps and right-sided polyps in LCI group were higher than those in WLI group (61.98% VS 47.17%, P=0.005; 60.94% VS 42.77%, P=0.001; 45.83% VS 32.70%, P=0.012). Conclusion:LCI can effectively improve the colorectal polyp detection rate, especially adenoma detection rate, which is worthy of clinical application.

目的 关注患者出院智慧结算方式的流程缺陷,运用科学管理方法,提高患者出院的智慧结算率,解决患者实际需求.方法 运用六西格玛管理法,医院多部门共同探讨影响患者出院结算方式选择的因素,分析智慧结算方式的流程缺陷,进行流程优化,并在临床大力推广.提高了患者出院智慧结算的便捷度和病房智慧结算率.结果 优化患者出院智慧结算流程后,患者出院使用智慧结算的比例大幅提高,出院带药的等药时间缩短,出院结算速度更快,床位周转率及患者满意度提高.结论 六西格玛管理法作为一种综合性质量管理方法,对需要多部门协作的管理活动非常适用,其中对流程的优化起到重要作用,该管理方法关注患者的需求,以患者满意为目标,对医院质量管理工作很有帮助.

目的 设计临床用血闭环式管理流程,优化用血管理信息系统,实现临床用血的全程可追溯.方法 总结临床用血管理流程的设计与实际应用效果,根据国家相关法律、法规及等级医院评审要求,结合医院实际情况,以信息化为载体,基于条形码和PDA扫码等信息技术对信息系统进行优化,对临床用血流程进行优化与再造.结果 根据临床用血规范构建的临床用血流程闭环式管理系统实现了医嘱-发血、取血-输血-病程记录全流程管理信息化,达到了预期目标.结论 临床用血闭环式管理流程的应用实现了责任全程可追溯,信息共享,全程条码化管理,使临床用血更加规范、标准与安全.

我国前列腺癌的患病人数不断上升,早发现、早治疗能明显提高患者生存率并改善其预后.超声及前列腺特异性抗原(PSA)检查作为筛查前列腺癌的方法临床上被广泛应用,然而在辨别前列腺良恶性病变上,两者特异性都较低.MRI因有较高的软组织分辨率,已被临床广泛应用于包括前列腺在内的软组织检查中.

Background Radix Astragali (Astragalus membranaceus var. mongholicus (Bunge)) and Coptis chinensis (Coptis chinensis var. angustiloba) are two commonly prescribed traditional Chinese herbs for diabetes. Astragalus Polysaccharide (AP) and Berberine (BBR) are active ingredients of these two herbs respectively and they are scientifically proved to have immunomodulatory and anti-inflammatory effects. They are also known for their antidiabetic potential by ameliorating insulin resistance (IR). AP and BBR have shown different advantages in treating diabetes according to previous reports. However, very few studies focus on the combined activities of the two potential antidiabetic ingredients. In this study, we discovered that reactive oxygen species (ROS) accumulated in IR-hepG2 cells and APBBR can decrease ROS level in model group significantly. We conjectured that APBBR can ameliorate IR in hepG2 cells by decreasing ROS level. In order to verify this hypothesis, we obtained phenotype and transcriptome information of IR-HepG2 cells and explore the underlying mechanism of the combination of AP and BBR(APBBR) activity on the relationship between ROS change in IR at whole-transcriptome level, so as to shed new light to efficacy and application of APBBR in treating diabetes. Methods The IR cell model was established with high-level insulin intervention. Glucose content, HepG2 cell viability as well as ROS level was detected to study the effect of IR-hepG2 cell phenotype. Unbiased genome-wide RNA sequencing was used to investigate alterations in experimental groups. Then, GO and KEGG functional enrichment was performed to explore the function and pathway of target genes. Venn analysis found out the differentially expressed lncRNAs that had close relationship with IR and ROS. Finally, we screened out candidate lncRNAs and these target genes to construct interaction network of differentiated lncRNA–miRNA–mRNA by according to the principle of competitive endogenous RNA (ceRNA). Results The biochemical experiments showed that APBBR administration could improve the proliferation activity of IR-HepG2 cells and decrease ROS level in model cells. The GO and KEGG functional enrichment analyses demonstrated several mRNAs remarkably enriched in biological processes and signaling pathways related to ROS production and IR progression. Interaction network suggest that APBBR ameliorates IR in HepG2 cells by regulating the expression of multiple genes and activating relevant signaling pathway to decrease ROS level. Thus, we demonstrated that APBBR ameliorated IR in hepG2 cells via the ROS-dependent pathway.

目的 探讨肩关节磁共振成像检查对冻结肩(FS)的临床及影像诊断的应用价值.方法 收集2017年12月至2019年6月期间本院治疗的90例FS患者作为FS组,按照临床分期分为三期,同期选择50例临床确诊为肩袖损伤的患者作为肩痛组,另选择50例正常成人作为对照组.对以上三组进行常规磁共振检查,分析影像特征,进行统计学分析.结果 三组组间比较,在喙肱韧带(Coracohumeral ligament,CHL)的增厚、腋囊的增厚、肩袖间隙关节囊的增厚以及喙突下脂肪三角的改变上都有明显的差异,并有统计学意义(P<0.05).FS组腋囊厚度、CHL厚度及肩袖间隙关节囊厚度高于肩痛组及对照组(P<0.05).结论 磁共振成像对冻结肩的诊断及临床分期具有较高的诊断价值,特别是腋囊增厚、CHL厚度增加、肩袖间隙关节囊增厚及喙突下脂肪三角征对FS患者的诊断具有较高的特异性.