目的 观察超声影像组学预测雌激素受体(ER)及孕激素受体(PR)双阴性乳腺癌的价值.方法 回顾性分析经病理确诊的342例乳腺癌359个病灶,326例可见单发、16例见多发病灶;其中119例见127个ER(-)PR(-)病灶、223例见232个其他病灶[36例共36个ER(+)PR(-)、2例共2个ER(-)PR(+)、185例共194个ER(+)PR(+)病灶];按照7∶3比例将病灶分为训练集(n=251)和测试集(n=108).基于术前超声资料提取1314个病灶影像组学特征,经预处理后获得1205个特征;采用最小绝对收缩和选择算子(LASSO)算法筛选最佳影像组学特征,并利用支持向量机以训练集数据进行训练,构建预测ER及PR双阴性乳腺癌的影像组学模型;绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估模型的诊断效能.结果 共筛选出37个最佳影像组学特征,以之构建的影像组学模型预测训练集和测试集ER及PR双阴性乳腺癌的AUC分别为0.872[95％CI(0.820,0.924)]和0.867[95％CI(0.798,0.936)].结论 超声影像组学可有效预测ER及PR双阴性乳腺癌.

目的:观察荣筋拈痛方对膝骨关节炎大鼠软骨组织自噬的影响,探讨其防治膝骨关节炎的作用机制.方法:将24只SD大鼠按照随机分层法分为假手术组、模型对照组、荣筋拈痛方组,每组8只.除假手术组外,其他组采用改良Hulth法复制膝骨关节炎模型.给药12周后,从假手术组和模型对照组中随机抽取3只大鼠拍摄膝关节MRI,观察模型是否成功.采集大鼠膝关节组织,HE染色法观察软骨组织形态结构,采用Mankin病理评分对关节软骨进行组织形态学评分;免疫组织化学法观察软骨组织酵母自噬相关基因6同源物(Beclin1)及微管相关蛋白Ⅰ轻链3B(LC3B)的定位与表达.结果:MRI显示,假手术组关节间隙正常,关节面平整;模型对照组关节间隙增宽,关节软骨面不平整、局部缺损,结缔组织增生,骨赘形成.荣筋拈痛方组大鼠骨关节炎模型关节软骨的大体外观及HE染色均改善明显,Mankin软骨评分高于模型对照组,差异有统计学意义(P<0.01).荣筋拈痛方组自噬蛋白Beclin1及LC3B表达均呈上升趋势.结论:荣筋拈痛方可能通过提高自噬相关蛋白Beclin1、LC3B的表达,改善软骨细胞状态,延缓关节软骨退变.

目的:观察荣筋拈痛方对白细胞介素-1β(IL-1β)诱导的体外大鼠软骨细胞自噬相关基因表达的影响,探讨其防治膝骨关节炎的作用机制.方法:取4周龄SD大鼠膝关节软骨,进行软骨细胞的体外分离培养,选取第2代软骨细胞甲苯胺蓝染色进行细胞鉴定.经IL-1β10 ng·mL-1诱导建立体外软骨细胞炎症模型,诱导成功后,给予荣筋拈痛方(50,100,200μg·mL-1)孵育48 h.将细胞分为空白对照组,模型对照组,荣筋拈痛方低、中、高剂量组.分别采用CCK-8法检测荣筋拈痛方对软骨细胞活性的影响,qPCR法检测软骨细胞中LC3Ⅱ、Beclin 1的mRNA表达,Western Blot法观察自噬蛋白LC3Ⅱ/Ⅰ比值、Beclin 1的蛋白表达水平.结果:与模型对照组比较,荣筋拈痛方低、中、高剂量组均显著提高细胞活力,呈剂量依赖性增加(P<0.01);模型对照组较空白对照组LC3Ⅱ、Beclin 1的mRNA及LC3Ⅱ/Ⅰ、Beclin 1的蛋白表达水平升高(P<0.05);经100μg·mL-1荣筋拈痛方干预后LC3Ⅱ、Beclin 1的mRNA及LC3Ⅱ/Ⅰ、Beclin 1的蛋白表达水平降低(P<0.05).结论:荣筋拈痛方可能通过抑制自噬水平,从而具有延缓膝骨关节炎退变的作用.

骨关节炎病位在体为筋骨,在脏为肝肾,两者相辅相成;肝肾相济则骨坚筋强,肝肾不足则骨痿筋弱.研究表明临床运用补肝肾、强筋骨类中药,可促进软骨细胞增殖,延缓软骨退变,但其具体作用机制尚不明确.故以补肝肾、强筋骨类中药及相关活性成分促进软骨细胞增殖为切入点,查阅文献并综述认为,其作用机制可能与促进细胞外基质合成、调控细胞周期相关蛋白、促进转化生长因子-β相关受体表达、调控细胞外调节激酶、Wnt信号通路及miRNA有关,可为进一步研究中药靶向治疗骨关节炎提供思路.

通过超声检查评估脾胃虚寒(弱)证和肝胃不和证餐后不适综合征(PDS)患者的胃容受性及胃排空功能的差异.方法收集2020年6月至2021年1月就诊于福建中医药大学附属第二人民医院脾胃病科的PDS患者共60例,其中脾胃虚寒(弱)证组32例,肝胃不和证组28例,另选健康志愿者15例为健康对照组.所有受试者均进行液体营养餐负荷试验,然后通过超声检查分别记录3组受试者阈值饮入量和最大饮入量,并通过超声测量比较3组受试者近端胃和远端胃饮后30、60、90、120 min时排空率情况及胃半排空时间情况.结果与健康对照组比较,脾胃虚寒(弱)证组最大饮入量少于健康对照组(P<0.05),肝胃不和证组阈值饮入量和最大饮入量均少于健康对照组(P<0.05);与肝胃不和证组比较,脾胃虚寒(弱)组阈值饮入量和最大饮入量均多于肝胃不和证组(P<0.05).与健康对照组比较,脾胃虚寒(弱)证组近端胃饮后60、120 min排空率及远端胃饮后120 min排空率均低于健康对照组(P<0.05),肝胃不和证组近端胃饮后120 min排空率低于健康对照组(P<0.05);与肝胃不和证组比较,脾胃虚寒(弱)证组近端胃饮后60、120 min排空率及远端胃饮后120 min排空率均低于肝胃不和证组(P<0.05).健康对照组比较,脾胃虚寒(弱)证组近端胃和远端胃半排空时间长于健康对照组(P<0.05),肝胃不和证组近端胃半排空时间长于健康对照组(P<0.05);与肝胃不和证组比较,脾胃虚寒(弱)证组远端胃和远端胃半排空时间均长于肝胃不和证组(P<0.05).结论超声检查能有效反映PDS患者的胃容受性及胃排空功能改变情况,其中脾胃虚寒(弱)证以胃排空延迟为主,肝胃不和证以胃容受舒张功能减弱为主,说明超声检查对PDS的诊断和治疗效果评估具有重要临床意义.

功能性消化不良属于功能性胃肠病的范畴,也是常见的身心疾病.随着人们生活压力的不断增加,该病发病率逐年升高,精神心理因素与该病发病密切相关.该文结合有关文献,探讨功能性消化不良与情志因素的相关性.

目的 探讨安全隐患自查模式对手术患者术后感染率的影响.方法 方便选取2019年1—6月、7—12月该院手术室手术患者120例设为对照组(n=60)、观察组(n=60),分别施行常规护理、安全隐患自查模式,比较术后感染发生率、心理状态评分、生活质量评分、护理满意度.结果 观察组术后感染发生率(1.67％)低于对照组(16.67％),差异有统计学意义(x2=8.107,P<0.05).护理后,观察组SAS、SDS评分为(40.74±4.93)分、(42.16±5.07)分,均低于对照组,差异有统计学意义(t=6.827、6.711,P<0.05).观察组生活质量各领域评分为(84.05±6.59)分、(84.39±6.28)分、(82.47±5.38)分、(83.62±5.71)分,均高于对照组,差异有统计学意义(t=5.649、5.737、6.204、6.791,P<0.05).观察组护理总满意率(98.33％)高于对照组(83.33％),差异有统计学意义(x2=8.107,P<0.05).结论 安全隐患自查模式用于手术室可降低患者术后感染风险,有利于调节患者心理状态,使其生活质量提升,使其更加满意于护理服务.

目的:基于生物信息学和网络药理学方法,筛选荣筋拈痛方君药牛膝相关活性成分,通过动物体内体外实验观察其对骨关节炎相关治疗靶点的影响.方法:通过中药系统药理学数据库与分析平台(TCMSP)数据库筛选中药牛膝主要活性成分和治疗靶点;通过GEO数据库获得与疾病的差异表达基因,并进行交叉分析;采用实时荧光定量聚合酶链式反应(Real-time PCR),蛋白免疫印迹法(Westemblot)检测牛膝主要活性成分对骨关节炎大鼠体内体外富集治疗靶点的影响.结果:牛膝作用骨关节炎相关活性成分共20种,槲皮素为其中重要成分之一;靶基因共3个,其中骨桥蛋白(OPN),纤维蛋白溶解抑制剂-1(PAI-1)等为该网络中的关键基因;基因本体(GO)分析共获得相关条目227条,涉及到的功能包括创伤生理反应调节(GO:1903034),创伤反应负调节(GO:1903035)等.京都基因与基因组百科全书(KEGG)通路分析获得相关通路12条,涉及细胞外基质受体相互作用(hsa04512)等.动物实验中,与正常组比较,模型组OPN,PAI-1 mRNA和蛋白表达量增加与模型组比较,槲皮素组OPN,PAI-1 mRNA和蛋白表达量降低(P＜0.05).细胞实验中,与正常组比较,模型组OPN,PAI-1蛋白表达量增加,Ⅱ型胶原(CollagenⅡ)蛋白表达量降低;与模型组比较,槲皮素组和抑制剂组OPN,PAI-1蛋白表达量降低,CollagenⅡ蛋白表达量明显增加(P＜0.05).结论:牛膝可能主要通过其活性成分(槲皮素)下调软骨细胞OPN,PAI-1靶mRNA表达,上调CollagenⅡ蛋白表达,实现抑制软骨退变,防治骨关节炎.

目的:基于核转录因子-κB(NF-κB)炎症相关信号通路,观察乌头汤水提物对脂多糖(LPS)诱导体外培养软骨细胞炎症模型的影响.方法:①制备乌头汤水提物;②分离、培养软骨细胞;③噻唑蓝(MTT)法检测乌头汤对LPS诱导软骨细胞活性的影响;采用Western Blot法检测NF-κB p65、IκB激酶复合物(IKK)、磷酸化核因子 κB抑制蛋白(pIκB)含量表达.结果:①MTT实验结果显示,乌头汤水提物对LPS诱导软骨细胞的最佳干预时间和浓度分别为24 h和150μg?mL-1;②Western Blot检测结果显示,乌头汤水提物100μg?mL-1组、150μg?mL-1组、200μg?mL-1组对LPS诱导的软骨细胞干预24 h后,可调节与炎症相关的NF-κB p65、IKK、pIκB含量表达,尤其以乌头汤水提物150μg?mL-1组变化显著(P<0.01).结论:乌头汤通过降低LPS诱导的软骨细胞中与炎症相关的NF-κB途径调节因子含量表达,发挥抗炎作用.

为改革教学考核方法,克服传统教学与考核方法的弊端,采用过程性考核评价体系对学生进行全面考查.研究结果显示,过程性考核体系这种新的考核模式的加入能够全面、及时、科学地反映学生的成绩和能力,极大地提高学生学习的兴趣,提高学习的积极性和主动性,提高教学质量.

目的 探讨肾嗜酸细胞腺瘤的超声特征.方法 回顾性分析2010年10月～2018年8月于我院经手术病理证实的24例肾嗜酸细胞腺瘤的声像图表现.结果 24例肾嗜酸细胞腺瘤均为单侧肾脏单发病灶,所有病灶均边界清晰,91.67％病灶形态规则,58.33％为高或稍高回声结节,66.67％结节内部回声均匀,12.50％结节可见液性区,20.83％结节未见明显血流信号.结论 肾嗜酸细胞腺瘤声像图有一定的特征性,检查医师应提高对本病的认识,详细检查,以提高诊断符合率.

目的 探讨经阴道三维超声多普勒(three-dimensional transvaginal ultrasound doppler,3D-TVUD)技术在评估不明原因复发性流产(recurrent spontaneous abortion,RSA)患者子宫内膜容受性(endometrial receptivity,ER)中的临床应用价值.方法 收集到我院就诊的32例RSA患者及30例对照组,比较种植窗期两组患者子宫动脉及螺旋动脉血流频谱参数、子宫内膜厚度、类型、容积和血管化血流参数如血管形成指数(VI)、血流指数(FI)、血管形成-血流指数(VFI)等各项参数的差异.结果 RSA患者子宫动脉及螺旋动脉血流阻力指数(RI)、搏动指数(PI)均高于对照组,差异有统计学意义(P＜0.05); RSA患者A型内膜数、子宫内膜厚度、容积、血管化血流参数(VI、FI、VFI)均小于对照组,差异有统计学意义(P＜0.05);而子宫动脉收缩期峰值流速(Vmax)两组间差异无统计学意义(P＞0.05).结论 3D-TVUD有助于评估不明原因RSA患者子宫内膜容受性,其参数可为临床诊断和疗效评估提供参考.

Objective:To observe the effect of Duhuo Jisheng decoction on the balance of calcium homeostasis and apoptosis of chondrocytes under endoplasmic reticulum stress(ERS), and to preliminarily explore its mechanism of preventing and treating osteoarthritis.Methods:A steady chondrocyte in vitro culture system was established by using 4-week-old SD rat knee cartilage, and identify the third generation chondrocyte by toluidine blue staining.The 25 μmol/L Thapsigargin(TG)was used to induce chondrocyte in vitro culture to produce endoplasmic reticulum stress(ERS), incubate it in Duhuo Jisheng Decoction(100, 200, 400 μg/mL)for 24 hours after induction.The cells were divided into the blank group, the model group, the low-dose Duhuo Jisheng decoction group, the medium-dose Duhuo Jisheng decoction group, and the high-dose Duhuo Jisheng decoction group.Then morphological changes of chondrocytes were observed respectively by inverted microscope, viability of chondrocyte in each group was examined by CCK-8 method, chondrocyte apoptosis was observed by Hoechst 33342 staining and real-time dynamic changes of intracellular Ca2+concentration was examined by double turntable laser confocal microscope.Results:①The morphology of chondrocytes: the cells in the blank group grew in a single-layer paving stone shape, while the cells in the model group increased in a polygonal shape, the pseudopodia increased, the gaps widened, and the number of cells decreased significantly.Compared with the model group, the number of cells in the three dose groups of Duhuo Jisheng decoction(100, 200, 400 μg/mL)increased significantly and the cytoplasm was uniform.The activity of chondrocytes in each group: compared with the blank group, the survival rate of the model group was lower, and the difference was statistically significant(P<0.05).The absorbance of each concentration group of Duhuo Jisheng decoction increased with the increase of concentration, and the difference was statistically significant compared with the model group(P<0.05).③Apoptosis of chondrocytes: the number of apoptosis in the model group was significantly increased, and the degree of pyknosis of the nucleus was obvious, and some of them were a high density of bright blue or half moon-shaped.The number of apoptotic cells in each dose group of Duhuo Jisheng decoction was significantly reduced, only a few apoptotic cells showed a high density of bright blue or half-moon shape, and the number of apoptosis decreased with the increase of the concentration of Duhuo Jisheng decoction, showing a certain dose-effect relationship.④The changes of intracellular calcium ion concentration: the calcium ion fluorescence intensity of the cells in the blank group was weaker and more uniform, maintaining a stable state.The calcium ion release of the model group was significantly increased, and the fluorescence intensity was enhanced.The fluorescence spectrum showed that calcium sparks were more frequent.Compared with the blank group, the difference was statistically significant(P<0.05).Chondrocytes in the medium and high-dose Duhuo Jisheng decoction groups could quickly return to calcium homeostasis, and calcium sparks were significantly reduced.Although there were still some calcium sparks in the low-concentration Duhuo Jisheng decoction group, the fluorescence intensity was significantly weaker than the model group.Conclusion:Duhuo Jisheng decoction has an inhibitory effect on the apoptosis of chondrocyte induced by TG, the mechanism may be that Duhuo Jisheng decoction can alleviate endoplasmic reticulum stress by regulating calcium balance, thus inhibiting the apoptosis of chondrocyte.

目的 应用Tei指数评估妊娠期肝内胆汁淤积症孕妇胎儿的整体心功能,为临床诊治ICP提供参考.方法 方便选取2017年6月—2019年1月该院ICP孕妇105例为研究对象,根据孕妇血清总胆汁酸水平分为A、B、C 3组,A组为重度ICP孕妇组(32例),孕妇血清总胆汁酸水平≥80μmol/L;B组为中度ICP孕妇组(35例),孕妇血清总胆汁酸水平≥40μmol/L、<80μmol/L;C组为轻度ICP孕妇组(38例),孕妇血清总胆汁酸水平≥10μmol/L、<40μmol/L;同时选择相同孕周的正常妊娠孕妇(50名)作为对照组(D组),孕妇血清总胆汁酸水平<10μmol/L.应用超声心动图测量胎儿的LVFS、LVEF、RVPCA及左、右心室的Tei指数,并进行比较分析.结果 4组胎儿LVFS均>28％,LVEF均>58％,RVPCA均>42％,组间比较差异无统计学意义(P>0.05);A、B、C、D 4组胎儿左心室Tei指数分别为(0.67±0.05)、(0.55±0.05)、(0.38±0.05)、(0.36±0.04);A、B、C、D 4组胎儿右心室Tei指数分别为(0.66±0.06)、(0.57±0.05)、(0.39±0.04)、(0.38±0.03);A组和B组左、右心室Tei指数明显高于C组和D组,差异有统计学意义(P<0.05);A组左、右心室Tei指数亦高于B组,差异有统计学意义(P<0.05);C组左、 右心室Tei指数与D组相比,差异无统计学意义(P>0.05).结论 Tei指数可以早期、准确、有效地评估中、重度ICP孕妇胎儿的左、右心室的整体心功能.

目的 探讨经阴道三维子宫输卵管超声造影(TVS 3D-HyCoSy)发生造影剂逆流的原因及预防措施.方法 回顾性分析181例不孕症患者TVS 3D-HyCoSy中造影剂逆流的发生情况及声像图特征,分析产生逆流现象的影响因素.结果 89例患者发生造影剂逆流现象(89/181,49.2％),继发性不孕(70/122,57.4％)患者逆流发生率高于原发性不孕患者(19/59,32.2％;P＜0.01);子宫内膜厚度≤6 mm患者(66/90,73.3％)逆流发生率高于子宫内膜厚度＞6mm者(23/91,25.3％;P＜0.01);双侧输卵管阻塞患者逆流发生率(25/40,62.5％)高于双侧输卵管通畅患者(7/22,31.8％;P＜0.05).Logistic回归分析显示:逆流发生的影响因素有不孕症类型、子宫内膜厚度和输卵管通畅性.结论 TVS 3D-HyCoSy造影剂逆流现象的发生与不孕症类型、子宫内膜厚度及输卵管通畅性有关;在造影过程中应该采取预防措施,降低逆流发生率,提高诊断准确度.

细胞焦亡是一种新近发现并已证实的伴随炎症反应的程序性细胞死亡方式,其经典炎症小体途径由半胱氨酸天冬氨酸蛋白酶1(caspase-1)介导,而caspase-1存在于大部分关节炎的滑膜组织中.越来越多的研究发现,细胞焦亡相关信号通路在关节炎的发展过程中扮演着重要的角色,因而细胞焦亡可能会为治疗关节炎提供全新的药物靶点.本文就细胞焦亡的特征和分子机制及与细胞焦亡相关的关节炎(骨关节炎、类风湿关节炎、强直性脊柱炎、痛风性关节炎)的研究进展进行了综述,以期为关节炎的治疗提供理论参考.

目的:观察狗脊多糖对硝普钠(SNP)诱导退变大鼠软骨细胞氧自由基的影响,为其在骨关节炎的临床应用提供理论依据.方法:采用水提醇沉法、Sevag法除蛋白提取纯化获得狗脊多糖,苯酚-硫酸比色法测定其多糖含量;酶联免疫吸附测定法分别检测体外培养大鼠软骨细胞空白对照组、模型对照组、各剂量狗脊多糖组(100,200,400,800μg?mL-1)的超氧化物歧化酶(SOD)、一氧化氮(NO)、丙二醛(MDA)的含量.结果:狗脊多糖含量为76.91%,精密度试验RSD=1.86%,表明仪器精密度良好,且稳定性试验RSD=1.98%,平均回收率试验为95.4%,RSD=1.83%;酶联免疫吸附法检测经SNP造模后软骨细胞氧自由基表达结果显示,与空白对照组比较,模型对照组SOD、NO、MDA含量表达差异均有统计学意义(P<0.01),提示软骨细胞退变模型建立;与模型对照组比较,各剂量狗脊多糖组(100,200,400,800μg?mL-1)干预48 h后,可上调SOD含量,下调NO、MDA含量,其中以200μg?mL-1组表达最显著(P<0.01).结论:苯酚-硫酸比色法可作为狗脊多糖的含量测定方法;狗脊多糖可降低经SNP造模后软骨细胞中异常氧自由基含量表达,上调抗氧化因子水平,发挥抗氧化作用.

Objective:To explore and discuss the curative effect of transvaginal 3D hysterosalpingo-contrast sonography for in-fertility. Methods:A total of 319 oviducts of 168 cases of infertile patient had been performed with transvaginal 3D HyCoSy in order to observe the tubal patency and uterine cavity lesion,62 cases of patient with intrauterine lesion and bilateral tubal ob-struction had been excluded,106 cases of patient who didn't receive a uterine laparoscopic surgery after the contrast-enhanced ultrasonography had been observed through follow-up visit for one year in order to carry out a statistics of their spontaneous pregnancy rate,they were divided as countercurrent group and non-countercurrent group and the difference between the two groups were compared. Results:The spontaneous pregnancy rate of 106 cases of patient was 23.6%,the difference in sponta-neous pregnancy rate between 0~6 months after contrast-enhanced ultrasonography (17.0%) and 7~12 months after contrast-enhanced ultrasonography (6.6%) was statistically significant (χ2=5.49,P<0.05). The spontaneous pregnancy rate of non-counter current group (30.8%) was higher than that of the countercurrent group (12.2%),the difference between both had a statistical significance (χ2=4.81,P<0.05). Conclusion:Transvaginal 3D HyCoSy is able to improve the spontaneous pregnancy rate of in-fertile patients within one year after the implementation of sonohysterography,having a certain curative effect.

Objective To discuss application value of transvaginal 3D-HyCoSy in female infertility.Methods By examining 62 infertile patients whom receiving laparoscopic surgery within two months after examination through HyCoSy to analyze the accuracy of fallopian tubal patency and uterine cavity diseases through HyCoSy.Results According to examination through 3D-HyCoSy,35 out of 115 oviducts of 62 patients were unobstructed,34 were partially passable and 46 were completely obstructed;the overall accuracy rate in the evaluation of tubal patency through HyCoSy is 81.74％,with no significant difference from the result of examination through peritoneoscopy(x2=0.23,P>0.05);the examination through HyCoSy suggested that 8 patients suffered intrauterine adhesion,9 suffered endometrial polyp,which were proved by examination through peritoneoscopy.Conclusion Transvaginal 3D-HyCoSy has a significant value in diagnosing tubal occlusion and uterine cavity diseases,and it is of great clinical significance in diagnosis of female infertility.

Medical Formulae Investigations is a comprehensive prescription monograph which is composed of pathology, methodology, formula and herbs. In the part of the monograph related to flaccidity, the etiology, pathogenesis, prescription and methodology of"five flaccidities"which are closely connected with diseases of heart, lung, liver and kidney have been described in detail. The authors in this article explore the characteristics of pathology, methodology, formula and herbs of"lung flaccidity", "pulse flaccidity", "tendon flaccidity", "bone flaccidity"and"atrophy flaccidity". Based on them, the roles of spleen and stomach in the treatment of"five flaccidities"are also discussed so as to provide theoretical evidence for clinical treatment and recovery of the related diseases.