头孢菌素联合青霉素治疗感染性肺炎新生儿的有效性与安全性

目的探讨头孢菌素联合青霉素对感染性肺炎新生儿血清炎性因子及肠道微生态环境的影响。方法选取2014年9月-2015年8月收治的90例感染性肺炎新生儿为研究对象,根据入院时间按照病历号随机分为头孢菌素组、青霉素组、头孢菌素联合青霉素组(联合组)各30例,分别给予头孢菌素、青霉素、头孢菌素联合青霉素治疗,治疗时间均为1周,比较3组感染性肺炎新生儿临床症状改善时间、血清炎性因子、肠道微生态环境、临床疗效等指标,同时选择35例正常未使用抗生素治疗的新生儿作为对照组。结果 3组治愈率比较,差异无统计学意义(84. 85%vs. 78. 79%vs. 81. 82%)(χ2=0. 987,P0. 05);联合组感染性新生儿发热、气促、喘憋、肺部啰音及哮鸣音等消失时间均明显短于头孢菌素组、青霉素组(4. 12±0. 56 vs.4. 45±0. 65 vs. 4. 47±0. 70,4. 08±0. 52 vs. 4. 58±0. 56 vs. 4. 59±0. 60,3. 85±0. 45 vs. 4. 32±0. 58 vs. 4. 35±0. 62,3. 78±0. 52 vs.4. 26±0. 62 vs. 4. 28±0. 70) d,(t=2. 029、3. 759、3. 678、3. 408、2. 243、3. 690、3. 749、3. 294,P0. 05);血清TNF-α、IL-6、hs-CRP水平均明显低于头孢菌素组、青霉素组[(7. 31±1. 42 vs. 8. 11±1. 46 vs. 8. 24±1. 51) pmol/L,(116. 58±17. 37 vs. 126. 47±20. 13 vs. 129. 30±20. 48) pg/ml,(50. 25±7. 14 vs. 58. 67±7. 50 vs. 61. 28±8. 63) ng/L](t=2. 256、2. 137、4. 671、2. 577、2. 721、5. 657,P0. 05);乳酸杆菌、双歧杆菌、肠球菌数量明显低于头孢菌素组、青霉素组,肠杆菌数量明显高于头孢菌素组、青霉素组(8. 86±0. 18 vs. 9. 00±0. 31 vs. 9. 05±0. 27,9. 39±0. 42 vs. 9. 63±0. 38 vs. 9. 72±0. 56,8. 18±0. 42 vs. 8. 56±0. 43 vs.8. 77±0. 56,9. 69±0. 57 vs. 9. 33±0. 52 vs. 9. 24±0. 61) log10n/g,(t=2. 244、2. 434、3. 632、3. 096、3. 364、2. 708、4. 842、2. 680,P0. 05)。结论青霉素、头孢菌素均是治疗新生儿感染性肺炎的有效药物,联合用药能迅速缓解感染性肺炎新生儿炎症状态,改善临床症状,但对患儿肠道正常微生态环境的影响也随之加大。     

早产危险因素meta分析

目的　综合分析中国早产发生的危险因素。方法　采用meta分析对国内 1994~2003年发表的有关早产危险因素的文献进行汇总、归纳和定量综合分析。结果　前置胎盘、产前出血、胎膜早破、多胎、臀位、妊高症、流产史、产前检查的合并OR值及其 95%C1分别为 7. 8781(5. 0103-12. 3876)、5. 4065(3. 009-8. 8552)、4. 4165(3. 2983-5. 9133)、4. 3601(2. 6414-7. 1973)、2. 7070(1. 8331~3. 9972)、2. 0432 (1. 3512-3. 0895)、1. 1651 (0. 7518 ~1. 8057)、0. 2946 (0. 2269 -0. 3824)。结论　前置胎盘、产前出血、胎膜早破、多胎、臀位、妊高症为早产的危险因素,流产史与早产的的关系尚不确定,产前检查为早产的保护因素。     

4种癌前病变筛查技术对宫颈癌筛查价值的Meta分析

目的运用循证学方法综合评估近10年肉眼观察法、Pap筛查、TCT及人乳头瘤病毒(HPV)筛查在宫颈癌诊断中的价值。方法计算机检索Pubmed、Cochrane、Web of Science、Embase、Medline、知网、中国生物数据库及医学文献数据库,通过诊断准确性研究质量评价工具(QUADAS-2)进行质量评价。采用随机效应模型合并分析灵敏度、特异度、阳性似然比、阴性似然比、诊断比值比及曲线下面积(AUC)。数据采用Stata 15. 0和Meta-Disc 1. 4软件进行统计分析。结果灵敏度合并值由高到低分别为HPV DNA筛查0. 94 [95%CI (0. 92~0. 96)]、TCT 0. 80 [95%CI (0. 75~0. 85)]、Pap筛查0. 72 [95%CI(0. 66~0. 77)]及肉眼观察法0. 50 [95%CI (0. 43~0. 57)];特异度由高到低分别为Pap筛查0. 97 [95%CI (0. 97~0. 98)]、肉眼观察法0. 93 [95%CI (0. 92~0. 94)]、HPV DNA筛查0. 90 [95%CI (0. 89~0. 91)]及TCT 0. 78 [95%CI (0. 76~0. 80)]。结论建议综合考虑技术成本和地区经济发展水平,选择适宜的宫颈癌筛查方案,尽最大可能满足我国妇女宫颈癌筛查的需求。     

三维超声与断层成像技术诊断宫内节育器位置异常的临床价值

目的探讨三维超声与断层成像技术应用于临床诊断宫内节育器位置异常的效果。方法选取2014年2月-2019年2月该院收治的80例疑似宫内节育器位置异常患者为研究对象,分别行二维阴道超声、三维阴道超声、三维阴道超声联合断层成像技术检查。最终结果以手术病理检查或宫腔镜检查为金标准。记录3种检查方法的检查结果,评价3种检查方法的准确度、灵敏度、特异度、误诊率、漏诊率、阳性预测值及阴性预测值。结果与金标准相比较,二维阴道超声检查的准确度、灵敏度、特异度、误诊率、漏诊率、阳性预测值及阴性预测值分别为63. 75%、57. 38%、84. 21%、15. 79%、42. 62%、92. 11%、38. 09%;异常结果:嵌顿15例、下移32例、变形3例、带器妊娠1例;三维阴道超声检查的准确度、灵敏度、特异度、误诊率、漏诊率、阳性预测值及阴性预测值分别为87. 50%、86. 89%、89. 47%、10. 53%、13. 11%、96. 36%、68. 00%;异常结果:嵌顿20例、下移45例、变形4例、带器妊娠1例;三维阴道超声联合断层成像技术检查准确度、灵敏度、特异度、误诊率、漏诊率、阳性预测值及阴性预测值分别为97. 50%、98. 36%、94. 74%、5. 26%、1. 64%、98. 36%、94. 74%;异常结果:嵌顿23例、下移43例、变形11例、带器妊娠1例。三维阴道超声联合断层成像技术检查的准确度、灵敏度、特异度、阳性预测值及阴性预测值明显高于二维阴道超声(χ~2=6. 35、9. 14、8. 11、7. 47、6. 98,均P=0. 00)、三维阴道超声(χ~2=8. 02、7. 30、8. 58、9. 66、9. 25,均P=0. 00),而误诊率、漏诊率明显低于二维阴道超声(χ~2=10. 55、18. 69,均P=0. 00)、三维阴道超声(χ~2=15. 54、16. 33,均P=0. 00);三维阴道超声检查的准确度、灵敏度、特异度及阴性预测值明显高于二维阴道超声检查(χ~2=9. 26、8. 88、12. 05、11. 67,均P=0. 00),误诊率、漏诊率明显低于二维阴道超声(χ~2=4. 14、12. 63,均P=0. 01),两者阳性预测值相比较,差异无统计学意义(χ~2=1. 02,P=0. 53)。结论临床采用三维阴道超声联合断层成像技术诊断女性宫内节育器异常可更加清晰地显示宫内节育器形态,从而提高诊断准确度,且该方法具有较好的灵敏度和特异度,避免误诊、漏诊发生。     

《中国医学创新》杂志继续医学教育培训试题（E）

33.子宫内膜异位症最容易累及的部位是（ ）A.直肠、B.输尿管、C.卵巢、D.输卵管、E.会阴侧切伤口;34.6岁患儿轻度贫血,Hb诊断范围为（ ）A.110-120g／L、B.90-110g／L、C.80-90g/L、D.60-90g／L、E.30-60g/L;     

科学泡脚攻略

[目的不同,加“料”有别]泡脚时加入一些中药包,可加强保健功效,刘清平主任表示,不同“佐料”会产生不同的妙用。她推荐了几道泡脚方——1.头痛:川芎、白芷、细辛、葱白.2.手脚冰冷:桂枝.当归、花椒、细辛、艾叶、生姜3.痛经:香附.元胡、当归、五灵脂4.手麻脚麻:桑叶、艾叶5.关节疼痛:生姜、艾叶、桂枝、桑枝、红花、伸筋草。     

自闭症患儿综合管理和干预效果评价分析

目的探讨自闭症患儿实施综合管理和干预的效果,为提高自闭症患儿的临床治疗效果提供有效的干预措施。方法将确诊的84例自闭症患儿随机分为对照组和观察组各42例,对照组给予常规治疗和康复训练,观察组在此基础上给予综合管理和干预措施;干预3个月后,比较两组患儿的日常行为发生率、行为能力评分及心理发展能力评分。结果干预后观察组患儿的情绪异常(16. 67%)、自我刺激行为(4. 76%)、刻板行为(7. 14%)、攻击破坏性(4. 76%)等发生率均低于对照组患儿(35. 71%、19. 05%、23. 81%及21. 43%),差异均有统计学意义(P 0. 05)。观察组患儿的感觉(6. 49±3. 26)、交往(13. 28±4. 84)、语言(18. 93±4. 56)及生活自理(14. 06±3. 87)评分均低于对照组患儿(8. 37±3. 40、15. 80±5. 09、22. 61±4. 83、16. 24±4. 38)评分,差异均有统计学意义(P0. 05)。观察组患儿的发展(9. 85±3. 12)、关系情感(3. 63±1. 39)、游戏及物件兴趣(3. 36±1. 27)、感觉反应(6. 31±2. 04)评分均低于对照组患儿(12. 74±3. 88、5. 35±1. 81、4. 40±1. 18、7. 49±2. 28)评分,差异均有统计学意义(P0. 05)。结论自闭症患儿通过综合管理和干预后可减少日常行为发生率,改善行为能力,提高心理发展能力,促进患儿早期康复。     

腹腔镜辅助阴式子宫切除治疗巨大子宫肌瘤的疗效及对患者肛门排气时间影响观察

目的研究腹腔镜辅助阴式子宫切除医治巨大子宫肌瘤的效果。方法取本院妇产科2017年11月—2018年11月接收的66例巨大子宫肌瘤病患资料,33例行开腹子宫切除(对照组),33例行腹腔镜辅助阴式全子宫切除(研究组),予两组临床指标、术后VAS评分、并发症对比。结果研究组下床活动、肛门排气、手术所用的时间及术中出血量(0. 96±0. 20) d、(23. 31±3. 44) h、(84. 92±9. 55) min、(53. 03±9. 64) ml优于对照组(2. 24±0. 35) d、(38. 52±4. 46) h、(94. 18±11. 16) min、(71. 66±9. 78) ml,比较差异具有统计学意义(P <0. 05),且术后5 h、10 h、20 h的VAS评分(2. 87±1. 48)分、(2. 30±1. 35)分、(1. 75±0. 81)分及并发症总发生率6. 06%低于对照组(5. 79±2. 67)分、(4. 01±2. 24)分、(2. 87±1. 50)分、24. 24%,比较差异具有统计学意义(P <0. 05)。结论巨大子宫肌瘤病患行腹腔镜辅助阴式子宫切除医治可减轻术后疼痛,降低并发症发生率,并缩短下床活动、肛门排气的时间。     

2015年武汉市中小学生早期创伤经历及其与心理弹性关联

目的了解武汉市中小学生早期创伤经历,探讨早期创伤经历与心理弹性的关联。方法于2015年9—10月整群抽样法选取武汉市10～15岁中小学生4871人,其中男生2517人,女生2354人,使用自编一般情况量表、儿童期创伤问卷(CTQ)和心理弹性量表(CD-RISC)进行自评问卷调查。结果调查对象CD-RISC平均得分为(64. 70±18. 34),不同的性别(t=5. 373,P <0. 001)、年龄(F=49. 401,P <0. 001)、母亲文化程度(F=36. 129,P<0. 001)、父母关系(F=89. 831,P<0. 001)和家庭经济状况(F=36. 547,P<0. 001)的心理弹性评分差异有统计学意义;早期创伤检出率为30. 1%,男生(χ~2=42. 272,P <0. 001)、母亲文化程度较低(χ~2=44. 345,P <0. 001)、父母关系较差(χ~2=133. 045,P<0. 001)、家庭经济状况较差(χ~2=31. 231,P <0. 001)的对象早期创伤检出率较高;情感虐待、躯体虐待、性虐待、情感忽视、躯体忽视与心理弹性总分均呈显著负相关(r值依次为-0. 256、-0. 107、-0. 053、-0. 355和-0. 308,P<0. 01);回归模型显示,中小学生性别、年龄、情感虐待、情感忽视和躯体忽视(标准化B依次为-0. 156、-0. 117、-0. 109、-0. 214和-0. 149,P<0. 01)对心理弹性有显著预测作用。结论较高的情感虐待、情感忽视和躯体忽视与儿童青少年心理弹性低有关,可通过避免或减少情感虐待、情感忽视和躯体忽视从而提升儿童青少年心理弹性。     

小柴胡汤的临床应用及其副作用探讨

小柴胡汤是<伤寒论>治少阳病的代表方剂.小柴胡汤由柴胡、黄芩、人参、半夏、甘草、生姜、大枣7味中药组成.方中柴胡、黄芩清热解少阳经腑之邪热,且又疏肝利胆,生姜、半夏和胃止呕.能升能降.以助柴胡之透达而散邪气,人参、炙甘草、大枣温补脾气.扶正祛邪以阻邪气内传太阴之络.也取肝病实脾之意.全方具有和解少阳、疏利肝胆、通达表里的作用.近年来小柴胡汤及其类方的应用范围不断扩大.广泛地应用于内外妇儿科.均取得了较好的疗效.     

Food classifications: Levels and categories

People classify foods into multiple categories to construct order in complex food environments. This investigation in the U.S. used depth interviews and secondary analysis of existing qualitative data sets to examine how the public constructs and uses food classifications. Within sets of culturally recognized food classifications, smaller sets of socially significant classifications are found, and within these socially significant classifications are sets of personally operational classifications used most often in making everyday food choices. Food classifications become salient and are used within specific contexts. Food classifications are multidimensional, and include many organizing themes such as liked/disliked, healthy/ unhealthy, seasonal/out of season, and others. These classification dimensions and categories vary in salience and use within and between individuals and settings. Understanding food classifications may help improve communication between food and health professionals and the public.     

The Varieties of Dignity

As a part of a research project on Dignity and Older Europeans (Fifth Framework (Quality of Life) Programme3) I explore in this paper a set of notions of human dignity. The general concept of dignity is introduced and characterized as a position on a value scale and it is further specified through its relations to the notions of right, respect and self-respect. I present four kinds of dignity and spell out their differences: the dignity of merit, the dignity of moral or existential stature, the dignity of identity and the universal human dignity (Menschenwürde). Menschenwürde pertains to all human beings to the same extent and cannot be lost as long as the persons exist. The dignity of merit depends on social rank and position. There are many species of this kind of dignity and it is very unevenly distributed among human beings. The dignity of merit exists in degrees and it can come and go. The dignity of moral stature is the result of the moral deeds of the subject; likewise it can be reduced or lost through his or her immoral deeds. This kind of dignity is tied to the idea of a dignified character and of dignity as a virtue. The dignity of moral stature is a dignity of degree and it is also unevenly distributed. The dignity of identity is tied to the integrity of the subject's body and mind, and in many instances, although not always, also dependent on the subject's self-image. This dignity can come and go as a result of the deeds of fellow human beings and also as a result of changes in the subject's body and mind.     

Utilisation des lipides : oxydation ou stockage ?

The stability of body weight and composition requires an equilibrium between the intakes and outputs of energy and macronutrients. Fat mass depends on the equilibrium between the input and output of lipid but also on the metabolic fate of lipids (oxidation or storage). Examination of metabolic pathways and of their regulation shows that cells have efficient biochemical and molecular mechanisms to stimulate acutely and on the long term carbohydrate oxidation, lipogenesis and lipid storage and to inhibit lipid oxidation. On the contrary, the ability of cells to acutely stimulate lipid oxidation is limited. These differences in regulation of lipid and carbohydrate metabolism are also present at the whole body level. The ability to increase lipid oxidation in response to an increased lipid intake is still more reduced in obese subjects. Despite numerous attempts to develop pharmacological approaches, modifications of dietary intakes and physical exercise remain the best ways to reduce lipid storage and to increase fat oxidation.     

Testing the Job Demand-Control-Support model with anxiety and depression as outcomes: the Hordaland Health Study

AIM: To test the strain/iso-strain, interaction and buffer hypotheses of the Job Demand-Control-Support model in relation to anxiety and depression. METHODS: Five thousand five hundred and sixty-two workers with valid Demand-Control-Support Questionnaire (DCSQ) scores were examined with the sub-scales of the Hospital Anxiety and Depression Scale as outcomes. Multiple statistical methods were applied. RESULTS: The strain and iso-strain hypotheses were confirmed. Generally, additive and non-interaction effects were found between psychological demands, control and social support. The buffer hypotheses were refuted. Results from analyses testing different interaction operationalizations were complementary. CONCLUSIONS: High demands, low control and low support individually, but particularly combined, are risk factors for anxiety and depression. Support is the DCSQ index most strongly associated with anxiety and depression in women. Assessment of psychosocial work environment may identify workers at risk, and serve as a basis for job-redesign.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Women at war: understanding how women veterans cope with combat and military sexual trauma

The wars in Iraq (Operation Iraqi Freedom, OIF) and Afghanistan (Operation Enduring Freedom, OEF) have engendered a growing population of US female veterans, with women now comprising 15% of active US duty military personnel. Women serving in the military come under direct fire and experience combat-related injuries and trauma, and are also often subject to in-service sexual assaults and sexual harassment. However, little is known regarding how women veterans cope with these combat and military sexual trauma experiences once they return from deployment. To better understand their experiences, we conducted semi-structured interviews with nineteen OEF/OIF women veterans between January-November 2009. Women veterans identified stressful military experiences and post-deployment reintegration problems as major stressors. Stressful military experiences included combat experiences, military sexual trauma, and separation from family. Women had varying abilities to address and manage stressors, and employed various cognitive and behavioral coping resources and processes to manage their stress.     

The problems associated with pesticide use by irrigation workers in Ghana

The use of pesticides in Ghanaian agriculture, though beneficialin reducing crop loss both before and after harvest, has beenassociated with threats to human health often due to the misapplicationof the chemicals. This study was an initial attempt to explorethe knowledge, attitudes and practices of 123 farm workers onthree irrigation project areas in the Accra Plains, Ghana, regardingthe safe handling and use of pesticides, to assess the prevalenceof symptoms associated with organophosphorus pesticides (OPs)and carbamates and to determine the prevalence of pesticide-relatedsymptoms, and blood cholinesterase. The study design was cross-sectionalin type. Methods used were interviews and observation, and biologicalmonitoring. The results revealed moderate levels of knowledgeof the routes of absorption of pesticides and of potential symptomsfollowing exposure. Knowledge of personal protective measureswas poor to moderate. High risk practices included frequenthandling of the chemicals, home storage of pesticides and shortre-entry intervals. Despite knowledge of some health risks associatedwith pesticides, the use of personal protective equipment (PPE)was minimal due primarily to financial constraints. The prevalenceof symptoms was higher and cholinesterase levels lower thanin a control group of teachers. It is suggested that there isa need for more epidemiologic studies to investigate the problemsassociated with pesticide induced ill health as well as researchinto appropriate and affordable PPE. PPE needs to be subsidized.Training of agriculture and health workers in safety precautions,recognition, and management of pesticide-related ill healthis a matter of urgency.     

胎儿唇腭裂产前诊断及预后研究现状

唇腭裂是最常见的颜面部畸形,对于该病的病因迄今尚未阐明,目前多认为该病是由于遗传、环境因素共同作用所致。中孕期通过超声、MRI等辅助检查方法可诊断胎儿唇腭裂。部分胎儿唇腭裂合并其他畸形,部分存在基因、染色体异常,影响患儿出生后生存质量及预后等,因此产前对胎儿唇腭裂的明确诊断至关重要。胎儿唇腭裂宫内手术治疗目前尚处于研究阶段,非综合征性唇腭裂(NSCL/P)患儿于婴幼儿期进行手术治疗后,多数可以康复。笔者拟就胎儿唇腭裂产前诊断及预后研究现状进行阐述,以提高临床对该病的诊治水平。     

Incidence and suspected cause of work-related musculoskeletal disorders, United Kingdom, 1996-2001

BACKGROUND: Musculoskeletal conditions are the most common self-reported work-related disease, with high costs incurred from long-term disability. In the United Kingdom, occupational physicians and rheumatologists have been reporting new cases of work-related musculoskeletal disorders to voluntary surveillance schemes since 1996. AIMS: To estimate population incidence rates for work-related musculoskeletal disorders reported by rheumatologists and occupational physicians by occupation and industry, in relation to tasks and movements suspected as causal. METHODS: Estimated average annual incidence rates were calculated for nine main job categories and eight industrial groups; Labour Force Survey figures were used as the denominator for rheumatologists, and a special survey for the occupational physicians. These were then related to tasks and movements reported as causal. RESULTS: Between October 1997 and the end of 2001, an estimated 2,599 new cases/year were reported by rheumatologists, and from January 1996, 5,278 cases/year by occupational physicians. Average annual rates overall were 94 per million for rheumatologists and 1,643 per million for occupational physicians (a 17-fold difference). Jobs at highest risk for the upper limb were primarily clerical, craft-related and machine work. Tasks associated with upper limb disorders and with neck and back problems were predominantly keyboard work and heavy lifting, and in craft-related occupations with gripping or holding tools. CONCLUSIONS: Jobs at risk and the associate tasks were identified which should assist prevention, but the extent to which these factors were causal or aggravating previous injury requires further study. The much higher rates reported by occupational physicians reflect, in part, the type of industries they served.     

The health promotion implications of the knowledge and attitude of employees in relation to health and safety leaflets

Selected aspects of the efficacy of printed leaflets produced by a government health and safety agency and widely distributed by the enforcement bodies and other organisations to promote workplace health and safety are examined. It is based on a study of 30 small or medium-sized enterprises and examines the views of 120 employers and employees regarding the availability, attractiveness, relevance and usefulness of the leaflets and estimates the reader comprehension and readability of the selected leaflets. The results indicate that the selected leaflets are considered acceptable and comprehensible by the majority of respondents. As these are typical of the leaflets available in the health and safety field this is a positive outcome. The discussion focuses around the ability of the leaflets to engage and to inform and suggestions are made to encourage a wider debate on the criteria which contribute to these two aspects of leaflet use. It is contended that leaflets will continue to be important in the attempts of those involved in workplace health and safety to facilitate learning and to contribute to the overall process of behaviour change. This study raises a number of key issues regarding the future design and use of such leaflets.