【摘要】 目的 總結非器質性呼吸困難患者的急診診治經驗，提高急診醫生對心理-生理性疾病的認識。 方法 對2005年-2009年急診科32例非器質性呼吸困難患者的診治經過進行回顧性分析。 結果 32例患者發病前均有精神創傷或過度勞累、精神緊張、或應急等心因性誘因；有典型的臨床癥狀；過度通氣激發試驗陽性；血氣分析提示呼吸性堿中毒；Nijmegen問卷積分≤23分者18例（56.2%）；輔助檢查未見其他原發性疾病。 結論 隨著現代社會身心壓力的增大，非器質性呼吸困難患者明顯增加，臨床醫生應加強對社會心理-生理性疾病的認識，提高診斷率，對減輕患者的精神壓力及避免過度醫療具有重要的臨床意義。【Abstract】 Objective To summarize the medical experiences of treating nonorganic dyspnea in the emergency department and raise physicians’ awareness of psychological-physiological diseases. Methods The clinical data of 32 patients with nonorganic dyspnea between 2005 and 2009 in the emergency department of our hospital were analyzed retrospectively. Results All the 32 patients had psychogenic incentives before onset of the disease, such as mental injury, over-exhaustion, nervousness or emergency. All of them had typical clinical manifestations. The results of hyperventilation provocation test were positive. Arterial blood gas analysis implied respiratory alkalosis. Eighteen of them (56.2%) had a mark ≤23 on the Nijmegen questionnaire. Auxiliary examinations showed no other primary diseases. Conclusions With the increase of emotional stress in the modern society, the number of patients with nonorganic dyspnea have markedly increased. Clinicians should strengthen the awareness of social psychology-physiological diseases, and improve diagnostic accuracy, which will have an obvious clinical value in relieving patients’ mental stress and avoiding excessive medical treatment.
Objective To investigate the effect of S-adenosyl-l-methionine (SAM) on oxidative stress and alveolar septal cell apoptosis in mice with emphysema after smoking cessation. Methods Twenty-two male SPF C57BL/6J mice aged 6 - 8 weeks were randomly divided into 4 groups, ie. a healthy control group, an emphysema group, a smoking cessation group, and a SAM intervention for 8 weeks after smoking cessation group, with 8 mice in each group. The mice model of emphysema was established by intraperitoneal injection of cigarette smoke extract (CSE) combined with cigarette smoke exposure. Smoking cessation started after the emphysema model was successfully constructed and lasted for 8 weeks. After smoking cessation, the mice in SAM intervention groups were intraperitoneally injected with SAM mg·kg–1·d–1 for 8 weeks. The right lung sections of the mice were taken for hematoxylin-eosin staining to observe pathological changes, and the mean linea rintercept (MLI) and mean alveola rnumber (MAN) of lungs were measured. The concentrations of malondialdehyde (MDA), superoxide-dismutase (SOD) and glutathione (GSH) in alveolar lavage fluid of left lung were detected by spectrophotometry. Terminal deoxynucleotidyl transferasemediated dUTP nick end labeling (TUNEL) technique was carried out to detect the alveolar septal cells apoptosis. Results MLI, apoptosis index of alveolar septal cell and MDA concentration in bronchoalveolar lavage fluid (BALF) increased significantly in the emphysema group compared with healthy controls, increased significantly in the smoking cessation group compared with the emphysema group, and decreased in the SAM intervention group compared with the smoking cessation group (all P<0.05). GSH concentration and SOD activity in BALF and MAN was significantly lower in the emphysema group compared with the healthy control group, significantly lower in the smoking cessation group compared with the emphysema group, and significantly higher in the SAM intervention group compared with the smoking cessation group (all P<0.05). Conclusions Lung histopathology and apoptosis of alveolar septal cells in emphysema mice progress continuously after smoking cessation. SAM may reduce oxidative stress and improve apoptosis of alveolar septal cells, so as to protect emphysema mice after smoking cessation.
【摘要】 目的 研究自貢市急救中心院前急救流行病學特征。 方法 回顧性分析2009年度自貢市急救中心出診的院前急救數據，研究院前急救疾病譜及性別、年齡構成，并分析時刻及季節分布特點，描述院前急救轉歸。 結果 2009年度自貢市急救中心院前急救共4 588例，排前6位疾病依次為損傷、中毒和外因的某些其他后果（45.6%），循環系統疾病（15.0%），呼吸系統疾病（6.3%），神經系統疾病（6.0%），精神和行為障礙（5.6%），消化系統疾病（4.9%）；性別構成男性多于女性（Plt;0.05）；年齡構成以中老年較多，青少年兒童較少（Plt;0.05）；時刻分布規律高峰點為15點40分（Plt;0.05），季節分布以冬季較多（Plt;0.05）；患者轉歸以住院、留院觀察為主，院前死亡人數占比例為3.8%。 結論 根據院前急救流行病學規律，可以合理配置急診資源，增強應急救援能力，滿足民眾不斷增加的醫療需求。【Abstract】 Objective To research on the epidemiological characteristics of the prehospital cases in Zigong emergency rescue center. Methods We retrospectively analyzed the database of prehospital cases in Zigong emergency rescue center in 2009, and reviewed the prehospital disease spectrum, gender composition, age structure, the circadian and seasonal distribution, and the outcomes of these cases. Results A total of 4 588 prehospital victims in Zigong emergency rescue center were enrolled. In the study, six leading diseases were injury, poisoning and certain other consequences due to external causes (45.6%), diseases of the circulatory system (15.0%), diseases of the respiratory system (6.3%), diseases of the nervous system (6.0%), mental and behavioral disorders (5.6%), and diseases of the digestive system (4.9%). Male patients were more than female patients (Plt;0.05). The proportion of the aged and the middle-aged was significantly larger than that of young population in the same districts (Plt;0.05), and the occurrence of prehospital care usually peaked at 15:40 (Plt;0.05). Prehospital care had a higher incidence in winter (Plt;0.05), and the outcome of prehospital cases was mainly in hospital and in observation ward. The proportion of deaths was 3.8%. Conclusion We can allocate emergency resources reasonably in prehospital care, and promote the ability of rescuing in order to meet people′s medical demands on the basis of the epidemiological study in our city.
Breast cancer is a malignancy caused by the abnormal proliferation of breast epithelial cells, predominantly affecting female patients, and it is commonly diagnosed using histopathological images. Currently, deep learning techniques have made significant breakthroughs in medical image processing, outperforming traditional detection methods in breast cancer pathology classification tasks. This paper first reviewed the advances in applying deep learning to breast pathology images, focusing on three key areas: multi-scale feature extraction, cellular feature analysis, and classification. Next, it summarized the advantages of multimodal data fusion methods for breast pathology images. Finally, the study discussed the challenges and future prospects of deep learning in breast cancer pathology image diagnosis, providing important guidance for advancing the use of deep learning in breast diagnosis.
Objective To evaluate the association between the Thr241Met polymorphism in the XRCC3 gene and the risk of lung cancer in Chinese population by meta-analysis. Methods Databases including PubMed, EMbase, CNKI, VIP and WanFang Data were searched to identify domestic and foreign case-control studies concerning the association between Thr241Met polymorphism in XRCC3 gene and the risk of lung cancer in Chinese population from the inception to August 20th, 2013. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted data and assessed quality. Then meta-analysis was performed using RevMan 5.0 software and Stata 10.0 software. Results A total of 5 case-control studies involved 2 999 lung cancer cases and 2 994 controls were included. The results of meta-analysis showed that, Chinese population who carry the variant genotype or allele had no increased risk of lung cancer: Met/Met vs. Thr/Thr: OR=1.00, 95%CI (0.38, 2.59), P=0.99; Met/Met vs. Thr/Met: OR=1.06, 95%CI (0.83, 1.36), P=0.63; Met/Met vs. Thr/Met+Thr/Thr: OR=0.99, 95%CI (0.38, 2.57), P=0.98; Thr/Met+Met/Met vs. Thr/Thr: OR=1.06, 95%CI (0.82, 1.37), P=0.65; Met vs. Thr: OR=1.05, 95%CI (0.82, 1.35), P=0.68. Conclusion Currently, Thr241Met polymorphism in the XRCC3 gene is not found to be associated with the risk of lung cancer in Chinese population. Considering the limited quality of the included case-control studies, more high quality studies with large sample size are needed to verify the above conclusion.
Spinal cord stimulation (SCS) for pain is usually implanted as an open loop system using unchanged parameters. To avoid the under and over stimulation caused by lead migration, evoked compound action potentials (ECAP) is used as feedback signal to change the stimulating parameters. This study established a simulation model of ECAP recording to investigate the relationship between ECAP component and dorsal column (DC) fiber recruitment. Finite element model of SCS and multi-compartment model of sensory fiber were coupled to calculate the single fiber action potential (SFAP) caused by single fiber in different spinal cord regions. The synthetized ECAP, superimposition of SFAP, could be considered as an index of DC fiber excitation degree, because the position of crests and amplitude of ECAP corresponds to different fiber diameters. When 10% or less DC fibers were excited, the crests corresponded to fibers with large diameters. When 20% or more DC fibers were excited, ECAP showed a slow conduction crest, which corresponded to fibers with small diameters. The amplitude of this slow conduction crest increased as the stimulating intensity increased while the amplitude of the fast conduction crest almost remained unchanged. Therefore, the simulated ECAP signal in this paper could be used to evaluate the degree of excitation of DC fibers. This SCS-ECAP model may provide theoretical basis for future clinical application of close loop SCS base on ECAP.
Objective To investigate the effects of one-lung ventilation time on the concentration of tumor necrosis factor (TNF)-α and interleukin (IL)-6 in the bronchoalveolar lavage fluid (BALF), serum inflammatory markers and early pulmonary infection after radical resection of esophageal cancer. Methods Ninety patients with thoracoscope and laparoscopic radical resection of esophageal carcinoma were chosen. According to the thoracoscope operation time, the patients were divided into 3 groups including a T1 (0.5–1.5 hours) group, a T2 (1.5–2.5 hours) group and a T3 (>2.5 hours) group. Immediately after the operation, the ventilated and collapsed BALF were taken. Enzyme-linked immunosorbent assay (ELISA) method was used to determine the concentration of IL-6 and tumour necrosis TNF-α. The concentrations of procalcitonin (PCT), C-reactive protein (CRP), and white blood cell (WBC) were measured on the first, third, fifth day after operation. The incidence of pulmonary infection was observed within 3 days after operation. Result The IL-6 values of the right collapsed lung in all groups were higher than those in the left ventilated lung. The TNF-α value of the right collapsed lung in the T2 group and T3 group was higher than that in the left ventilated lung (P<0.05). Compared with in the right collapsed lung, the TNF-α and IL-6 values gradually increased with the the duration of one-lung ventilation (P<0.05). Compared with the left ventilated lung groups, the IL-6 value increased gradually with the duration of one-lung ventilation time (P<0.05). The TNF-α value of the T3 group was higher than that of the T1 and T2 groups (P<0.05). The PCT value of the T3 group was higher than that of the T1 group and T2 group on the third, fifth day after operation (P<0.05). But there was no significant difference in CRP and WBC among the three groups at different time points. The incidence of pulmonary infection in the T3 group was significantly higher than that in the T1 group within 3 days after operation (P<0.05). Conclusion With the extension of one-lung ventilation time, the release of local and systemic inflammatory mediators is increased, and the probability of pulmonary infection is higher.
Bioartificial liver support system (BALSS) provides a new way to treat liver failure and leaves more time for patients who are waiting for liver transplantation. It has detoxification function as well as the human liver, at the same time it can provide nutrition and improve the internal environment inside human body. Bioreactors and hepatocytes with good biological activity are the cores of BALSS which determine the treatment effect. However, in the course of prolonged treatment, the function and activity of hepatocytes might be greatly changed which could influence the efficacy. Therefore, it is very important to detect the status of the hepatocytes in BALSS. This paper presents some common indicators of cell activity, detoxification and synthetic functions, and also introduces the commonly detection methods corresponding to each indicator. Finally, we summarize the application of detection methods of the hepatocyte status in BALSS and discuss its development trend.
ObjectiveTo explore the significance of continuous surveillance of anti-endothelial cell antibody (AECA) in patients with chronic obstructive pulmonary disease (COPD) in one year.MethodsThirty-six patients with acute exacerbation of COPD and 93 patients with stable COPD were selected from Guizhou Provincial People's Hospital from October 2019 to February 2020, thirty healthy people in the same period were selected as normal control group. In the stable phase group, >386.17 pg/mL was included in the higher group, and <386.17 pg/mL was included in the lower group according to the AECA median (386.17 pg/mL). According to the grouping criteria, the patient with the AECA median was omitted, the sample size of AECA higher group and lower group accounted for 46 cases, respectively. AECA test, lung function examination, the number of acute exacerbations in the past 1 year and MMRC score were performed for each group; At the same time, all the above contents were followed up dynamically.Results1. Comparison of AECA levels among the three groups: the acute exacerbation COPD group was higher than the stable phase group and the normal control group, and the stable phase group was higher than the normal control group, with statistical significance (all P<0.05). 2. Overall comparison of related indicators before and after follow-up in COPD stable period group: AECA level was higher than baseline after follow-up, and the follow-up after 12 months was higher than that after 6 months; After 12 months, forced expiratory volume in one second (FEV1), the ratio of FEV1 to forced vital capacity (FVC), and FEV1%pred were all lower than baseline, and the first two indexes were lower than those after 6 months follow-up. The number of acute exacerbations and mMRC score after 12 months were higher than that after 6 months follow-up, with statistical significance (all P<0.05). 3. Comparison of related indicators after follow-up between the higher and lower AECA groups: Follow-up after 12 months showed that AECA, the number of acute exacerbations and mMRC score in the higher AECA group were all higher than those in the lower AECA group at the same period, and the number of acute exacerbations and MMRC score in the higher AECA group were higher than those in the lower AECA group at 6-month follow-up. The FEV1, FEV1%pred and FEV1/FVC of the higher AECA group followed up after 12 months were lower than those of the lower AECA group at the same period, and the FEV1 and FEV1%pred of the higher AECA group followed up after 6 months were lower than those of the lower AECA group at the same period, and all the differences were statistically significant (all P<0.05).ConclusionAbnormality of AECA expression in COPD may be associated with continued decline in lung function, number of acute exacerbations in the previous 1 year, and increased mMRC score, and therefore may be associated with continued progression.
Objective To investigate the relatingship between leptin receptor gene Gln223Arg polymorphism and obstructive sleep apnea hyponea syndrome (OSAHS) in Han population in Southwest China. Methods Two hundred and fifteen cases of subjects (including 116 cases in OSAHS group and 99 cases in control group) were selected in Han population in Southwest China. Polymerase chain reaction (PCR) was used to analyse Gln223Arg leptin receptor gene polymorphism. The levels of serum LEP and TI were determined by double antibody sandwich enzyme-linked immunosorbent assay (ELISA). Simultaneous determination of body mass index (BMI) and neck circumference (NC) and waist circumference (WC) were conducted. Results In the OSAHS group, the leptin receptor gene polymorphism Gln223Arg GG, AA and GA genotype frequency was 0.854, 0.017 and 0.129, respectively. G allele and A allele frequency frequency was 0.918 and 0.082, respectively. In the control group, leptin receptor gene polymorphisms Gln223Arg GG, AA and GA genotype frequency was 0.840, 0.020 and 0.14,respectively. G allele and A allele frequency was 0.90 and 0.10, respectively. Genotype frequencies of the two groups were not statistically significant (χ2=0.784, P>0.05). There were differences in BMI, WC and NC between the OSAHS patients with GG and the OSAHS patients with (GA+AA) genotype (P<0.05), but no difference was found in LEP and TI levels (allP>0.05). In control, mild, moderate and severe OSAHS group, the levels of serum LEP and TI were increased gradually, and the difference was statistically significant (allP<0.05). Conclusions Gln223Arg leptin receptor genotype polymorphisms may be involved in obesity, but they have no relationship with the incidence of OSAHS in Han population in Southwest China. In OSAHS patients, Gln223Arg polymorphism has no relationship with LEP or TI. Patients with OSAHS have hyperleptinemia and hyperinsulinemia.